Expansion of an iliac aneurysm after treatment with multilayer stent: an unusual case

A 62 year old man, suffering from arterial hypertension and no other significant comorbidities come to our attention for the presence of an asymptomatic 29 mm left common iliac artery (CIA) aneurysm and bladder cancer. Given the young age of the patient, we opted for endovascular treatment that would allow to maintain the patency of the hypogastric artery. In June 2011, the patient underwent an endovascular exclusion of the left iliac artery aneurysm corrected by multilayer stent placement (Cardiatis 16x120mm) and post-dilatation with 14x40 mm balloon (Medtronic Reliant). At the 3 months follow-up, a CT-angio was made, showing a Type I endoleak with complete perfusion of the aneurismal sac. We analysed the CT-Angio using OsiriX and at the 3D reconstruction a poor adhesion of the stent to the proximal neck was detected. We decided to intervene by implanting two balloon-expendable covered stents (Atrium Adventa; 16x40 mm) The aneurysm sac remained stable for 9 months but at 12 months follow-up the aneurysm presented a diameter of 39mm. Due to the increase of the aneurysm sac, we decided to implant a stent-graft 16-10x95+10-10x80 mm (Medtronic Endurant) with complete exclusion of the aneurysm and internal iliac artery occlusion. At one month follow-up the patient is completed asymptomatic with no endoleak at the Duplex scan and at the CT-Angio.