Abstract
Background To report a case of a high-risk patient treated with hypogastric chimney and aortic
endograft for a native infrarenal aorta aneurysmal degeneration, 20 years after an
aortobifemoral bypass procedure for severe iliac occlusive disease.
Methods A two-stage procedure was planned. The first stage was right internal iliac artery
(IIA) embolization and simple angioplasty of left IIA. The second stage consisted
of aortouniiliac endograft with femoral crossover and left IIA chimney.
Results Femoral crossover complicated with early thrombosis, but a decision on conservative
medical treatment with anticoagulation was made based on no rest pain or severe claudication.
After 3 months the patient presented with moderate claudication alone. Scheduled computed
tomography scan showed femoral crossover graft and aortic endograft thrombosis with
left IIA patency. The axillofemoral bypass was scheduled a week later, and the patient
discharged home.
Conclusion Preservation of pelvic circulation is mandatory to avoid life-threatening complications.
The chimney technique demonstrates good patency and should be considered in the endovascular
approach armamentarium for hypogastric artery revascularization.
Keywords
EVAR - chimney technique - hypogastric artery - endograft thrombosis - endovascular
procedure - limb ischemia - endograft occlusion
