The Vascular Patient - Chronic Mesenteric Ischemia, AAA and Iliac Occlusion

Peripheral arterial disease (PAD), abdominal aortic aneurysm (AAA) and chronic mesenteric ischaemia (CMI) are vascular diseases uncommonly observed in the same patient, especially when treatment is required. This case report illustrates a patient requiring mesenteric revascularization due to CMI. A long flush occlusion of the superior mesenteric artery (SMA) precluded endovascular revascularization. Therefore, we performed a retrograde bypass from the right common iliac artery (CIA) to the SMA. On the 6-month follow-up, the patient developed right limb ischemia despite the absence of intestinal angina. CT angiography revealed CIA occlusion, bypass patency through hypogastric retrograde filling and modest growth of a AAA. Due to the presence of contralateral CIA lesions and to achieve durable revascularization, we opted to perform a AAA repair with an aorto-uni-iliac endograft followed by a femorofemoral crossover bypass. This achieved AAA's repair, lower limb revascularization, and a suitable and durable inflow to the mesenteric bypass.