Hypogastric Chimney Patency in Aortic Monoiliacal Endograft Thrombosis: A Life Saved by Collateral Pelvic Circulation

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

• References

• 1 Lepidi S, Piazza M, Scrivere P. , et al. Parallel endografts in the treatment of distal aortic and common iliac aneurysms. Eur J Vasc Endovasc Surg 2014; 48 (01) 29-37
• 2 Noel-Lamy M, Jaskolka J, Lindsay TF, Oreopoulos GD, Tan KT. Internal iliac aneurysm repair outcomes using a modification of the iliac branch graft. Eur J Vasc Endovasc Surg 2015; 50 (04) 474-479
• 3 Rhee RY, Muluk SC, Tzeng E, Missig-Carroll N, Makaroun MS. Can the internal iliac artery be safely covered during endovascular repair of abdominal aortic and iliac artery aneurysms?. Ann Vasc Surg 2002; 16 (01) 29-36
• 4 Karch LA, Hodgson KJ, Mattos MA, Bohannon WT, Ramsey DE, McLafferty RB. Adverse consequences of internal iliac artery occlusion during endovascular repair of abdominal aortic aneurysms. J Vasc Surg 2000; 32 (04) 676-683
• 5 Jean-Baptiste E, Brizzi S, Bartoli MA. , et al. Pelvic ischemia and quality of life scores after interventional occlusion of the hypogastric artery in patients undergoing endovascular aortic aneurysm repair. J Vasc Surg 2014; 60 (01) 40-49 , 49.e1
• 6 Mehta M, Veith FJ, Ohki T. , et al. Unilateral and bilateral hypogastric artery interruption during aortoiliac aneurysm repair in 154 patients: a relatively innocuous procedure. J Vasc Surg 2001; 33 (2, Suppl): S27-S32
• 7 Eagleton MJ, Shah S, Petkosevek D, Mastracci TM, Greenberg RK. Hypogastric and subclavian artery patency affects onset and recovery of spinal cord ischemia associated with aortic endografting. J Vasc Surg 2014; 59 (01) 89-94
• 8 Reyes A, Donas KP, Pitoulias G, Austermann M, Gandarias C, Torsello G. Complementary Role of Fenestrated/Branched Endografting and the Chimney Technique in the Treatment of Pararenal Aneurysms After Open Abdominal Aortic Repair. J Endovasc Ther 2016; 23 (04) 599-605
• 9 Thurley PD, Glasby MJ, Pollock JG. , et al. Endovascular management of delayed complete graft thrombosis after endovascular aneurysm repair. Cardiovasc Intervent Radiol 2010; 33 (04) 840-843
• 10 Alder L, Al-Jarrah Q, Rahi MA, Wilde N, Al-Khaffaf H. Percutaneous catheter-directed thrombolysis for treatment of complete body and bilateral limb endovascular aortic graft occlusion. EJVES Extra 2012; 24: e37-e38