Complex Aortoiliac Pelvic And Visceral Revascularization

Aortoiliac occlusive disease (AIOD) remains an area of debate concerning open and endovascular treatment options. A case of a 63-year old female is reported, with previous known vascular intermittent claudication, that presented in the emergency room with acute ischemia of the right lower limb with 24-hours of evolution. The computer tomographic angiography unveiled occlusion of the superior mesenteric artery, occlusion of left common iliac artery (CIA), subocclusive stenosis of right CIA, occlusion of distal runoffs vessels in the right lower limb and diffuse aorto-iliac disease. The first approach was to place the patient under catheter directed thrombolysis (48h) which led to right pedal pulse recovery but the occlusion of left CIA remained. The patient was then electively submitted to Covered Endovascular Repair of Aortic Bifurcation (CERAB) with chimney to inferior mesenteric artery and with an additional bailout left iliac sandwich due to dissection. Distal pulses are still present after 18 months of follow-up. Endovascular techniques provide a low morbimortality option with similar symptomatic improvement, challenging open surgery as the standard of care even in complex AIOD.