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Contents
xxi
79 Endovascular Repair of a Large Ruptured
Popliteal Aneurysm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355
Physical Examination and History . . . . . . . . . . . . . . . . . . . . . . . . 355
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 356
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357
Part XXII Endovascular Repair of Splenic Artery Aneurysm
80 Endovascular Repair of Splenic Artery Aneurysm . . . . . . . . . 361
Physical Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
Invited Commentary from Timur P. Sarac, MD . . . . . . . . . . . . . . 363
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
Part XXIII Carotid Stenting
81 Carotid Stenting for Symptomatic Carotid Restenosis
Secondary to Myointimal Hyperplasia . . . . . . . . . . . . . . . . . . . 367
History and Physical Examination . . . . . . . . . . . . . . . . . . . . . . . . 367
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
82 Carotid Artery Stenting for Symptomatic
Radiation- Induced Carotid Stenosis . . . . . . . . . . . . . . . . . . . . . 371
Physical Examination and History . . . . . . . . . . . . . . . . . . . . . . . . 371
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
Invited Commentary from Hitinder S. Gurm, MBBS . . . . . . . . . . 374
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374
83 Carotid Stenting for Carotid Interposition
Vein Graft Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
History and Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377
84 Carotid Artery Stenting for Recurrent Internal Carotid
Artery Stenosis with Contralateral Internal Carotid
Artery Occlusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
History and Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 380
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 380
85 Carotid Stenting and Redo Carotid Endarterectomy
in Patient with Bilateral Recurrent Carotid Stenosis
with Type III Aortic Arch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381
History and Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
xxii
Part XXIV Iliac Stenting
86 Iliac Stenting for Chronic Total Occlusion
Using Brachial Artery Access . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 389
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 389
87 Covered Stent Placement for Flush Occlusion
of Common Iliac Artery: A 12-Year Follow-Up . . . . . . . . . . . . 391
Physical Examination and History . . . . . . . . . . . . . . . . . . . . . . . . 391
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 392
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393
88 Covered Iliac Stenting for Acute on Chronic Ischemia
Following Thoracotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395
History and Physical Examination . . . . . . . . . . . . . . . . . . . . . . . . 395
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 398
89 Management of Iliac Stent Thrombosis . . . . . . . . . . . . . . . . . . 399
History and Physical Examination . . . . . . . . . . . . . . . . . . . . . . . . 399
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 402
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 402
Contents
90 Iliac Stenting Complicated by Iliac Artery Rupture . . . . . . . . 403
Physical Examination and History . . . . . . . . . . . . . . . . . . . . . . . . 403
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 404
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405
Part XXV Aorto-Iliac Stenting
91 Aortic Stenting for Isolated Aortic Stenosis
at the Level of the Inferior Mesenteric Artery . . . . . . . . . . . . . 409
Physical Examination and History . . . . . . . . . . . . . . . . . . . . . . . . 409
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411
92 Covered Bilateral Iliac Artery Stenting with Extension into
Common Iliac Arteries for Near Occlusion of Distal Aorta . . 413
Physical Examination and History . . . . . . . . . . . . . . . . . . . . . . . . 413
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415
Contents
xxiii
Part XXVI Percutaneous Intervention for Infrainguinal
Arterial Disease
93 Percutaneous Intervention for Infrainguinal Arterial
Occlusive Disease with Heel Ulcer . . . . . . . . . . . . . . . . . . . . . . . 419
Physical Examination and History . . . . . . . . . . . . . . . . . . . . . . . . 419
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 424
94 Angioplasty for Femoral-Tibial in Situ Vein Bypass
Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425
Patient A: History and Procedure . . . . . . . . . . . . . . . . . . . . . . . . . 425
Patient B: History and Procedure . . . . . . . . . . . . . . . . . . . . . . . . . 425
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430
Part XXVII Endovascular Therapy for Mesenteric Ischemia
95 Management of Radiation- Induced Superior Mesenteric
Artery Stenosis with Small Bowel Ischemia . . . . . . . . . . . . . . . 433
Physical Examination and History . . . . . . . . . . . . . . . . . . . . . . . . 433
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 436
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 437
96 Superior Mesenteric Artery In-stent Restenosis . . . . . . . . . . . 439
Physical Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 440
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 441
97 Endovascular Treatment of Symptomatic Celiac
and Superior Mesenteric Artery Occlusive Disease . . . . . . . . . 443
Physical Examination and History . . . . . . . . . . . . . . . . . . . . . . . . 443
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 444
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 446
Part XXVIII Renal Artery Stenting
98 Renal Artery Stenting for Renal Vascular Hypertension
in a Patient with Solitary Kidney . . . . . . . . . . . . . . . . . . . . . . . 449
History and Physical Examination . . . . . . . . . . . . . . . . . . . . . . . . 449
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 452
Part XXIX Subclavian Artery Stenting
99 Subclavian Artery Stenting for Ischemic Left Index Finger . . 455
Physical Examination and History . . . . . . . . . . . . . . . . . . . . . . . . 455
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455
xxiv
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 456
Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 457
Part XXX Acquired Arteriovenous Fistula
100 Acquired Arteriovenous Fistula of the Axillary Artery . . . . . . 461
Physical Examination and History . . . . . . . . . . . . . . . . . . . . . . . . 461
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462
Invited Commentary from Nitin Jain, MD, MS
(Master of Surgery) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 463
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 463
Part XXXI Question Set
101 100 Multiple Choice Questions . . . . . . . . . . . . . . . . . . . . . . . . . 467
Part I Open Repair of Intact Abdominal Aortic Aneurysm . . . . . . 467
Part II Open Repair of Ruptured Abdominal Aortic Aneurysm . . . 469
Part III Open Repair of Intact and Ruptured Iliac
Artery Aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469
Part IV Open Repair of Femoral Artery and Femoral
Anastomotic Aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 470
Part V Open Repair of Popliteal Artery Aneurysms . . . . . . . . . . . 470
Part VI Open Repair of Subclavian- Axillary Aneurysm . . . . . . . . 470
Part VII Open Repair of Carotid Aneurysm . . . . . . . . . . . . . . . . . 470
Part VIII Open Repair of SMA Aneurysm . . . . . . . . . . . . . . . . . . 471
Part IX Resection of Carotid Body Tumor . . . . . . . . . . . . . . . . . . 471
Part X Carotid Endarterectomy . . . . . . . . . . . . . . . . . . . . . . . . . . 471
Part XI Aortofemoral Grafting . . . . . . . . . . . . . . . . . . . . . . . . . . . 472
Part XII Aortomesenteric Bypass . . . . . . . . . . . . . . . . . . . . . . . . . 473
Part XIII Infrainguinal Arterial Bypass Graft . . . . . . . . . . . . . . . . 473
Part XIV Adventitial Cystic Disease of the Popliteal Artery . . . . 473
Part XV Popliteal Venous Pseudoaneurysm and
Arteriovenous Fistula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 474
Part XVI Endovascular Aneurysm Repair for Intact
Abdominal Aortic Aneurysm . . . . . . . . . . . . . . . . . . . . . . . . . . . . 474
Part XVII Endovascular Aneurysm Repair for Ruptured
Abdominal Aortic Aneurysm . . . . . . . . . . . . . . . . . . . . . . . . . . . . 474
Part XVIII Endovascular Repair for Large Iliac and Hypogastric
Aneurysms Following Open Abdominal Aortic Aneurysm
Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 475
Part XIX Endovascular Repair for Hypogastric
Aneurysm Following EVAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 475
Part XX Thoracic Endovascular Aneurysm Repair. . . . . . . . . . . . 475
Part XXI Endovascular Repair for Popliteal Artery Aneurysm . . 476
Part XXII Endovascular Repair of Splenic Artery Aneurysm . . . 476
Part XXIII Carotid Stenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 476
Part XXIV Iliac Stenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 476
Part XXV Aortoiliac Stenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477
Part XXVI Percutaneous Intervention for Infrainguinal
Arterial Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477
Contents
Contents
xxv
Part XXVII Endovascular Therapy for Mesenteric Ischemia . . . . 477
Part XXVIII Renal Artery Stenting . . . . . . . . . . . . . . . . . . . . . . . . 478
Part XXIX Subclavian Artery Stenting . . . . . . . . . . . . . . . . . . . . . 478
Part XXX Acquired Arteriovenous Fistula . . . . . . . . . . . . . . . . . . 478
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 479
List of Invited Discussants
CharlesW.Acher, MD Vascular Surgery, Department of Surgery, University
of Wisconsin Madison, Madison, WI, USA
FaisalAziz, MD, DFSVS, FACS Division of Vascular Surgery, Penn State
Heart and Vascular Institute, Pennsylvania State University College of
Medicine, Hershey, PA, USA
Paul G. Bove, MD, FACS, FSVM Department of Surgery, Oakland
University William Beaumont School of Medicine, Rochester, MI, USA
Sections of Vascular Surgery and Surgical Critical Care, William Beaumont
Hospital, Troy, MI, USA
MarvinChau, BS Department of Medical Education, Pennsylvania State
University College of Medicine, Hershey, PA, USA
BenjaminD.Colvard, MD Division of Vascular Surgery and Endovascular
Therapy, Department of Surgery, University Hospitals Cleveland Medical
Center, Case Western Reserve University, Cleveland, OH, USA
FrankM.Davis, MD Section of Vascular Surgery, Department of Surgery,
University of Michigan, Ann Arbor, MI, USA
Audra A. Duncan, MD, FACS, FRCSC Division of Vascular Surgery,
Department of Surgery, University of Western Ontario, London, ON, Canada
PeterGloviczki, MD Division of Vascular and Endovascular Surgery, Mayo
Clinic; Journal of Vascular Surgery, Rochester, MN, USA
HitinderS.Gurm, MBBS Department of Internal Medicine, University of
Michigan, Ann Arbor, MI, USA
Peter K. Henke, MD Department of Surgery, Michigan Medicine, Ann
Arbor, MI, USA
KarenJ.Ho, MD Department of Surgery, Northwestern University Feinberg
School of Medicine, Chicago, IL, USA
Nitin Jain, MD, MS (Master of Surgery) Department of Interventional
Radiology, Ascension St. John Macomb and Oakland Hospitals, Michigan,
Warren, MI, USA
xxvii
xxviii
VikramS. Kashyap, MD Division of Vascular Surgery and Endovascular
Therapy, Department of Surgery, University Hospitals Cleveland Medical
Center, Case Western Reserve University, Cleveland, OH, USA
GrahamW.Long, MD Department of Surgery, Oakland University William
Beaumont School of Medicine, Royal Oak, MI, USA
M.AshrafMansour, MD, MBA, FACS Department of Surgery, Spectrum
Health, Michigan State University, Grand Rapids, MI, USA
MarkD.Morasch, MD, FACS Department of Vascular Surgery, St. Mark’s
Hospital, Salt Lake City, UT, USA
RaghuL.Motaganahalli, MD Department of Surgery, Division of Vascular
Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
Nicolas J.Mouawad, MD, MPH, MBA,FSVS,FACS,FRCS,RPVI
Vascular & Endovascular Surgery, McLaren Bay Heart & Vascular,
Department of Surgery, McLaren Bay Region, Bay City, MI, USA
DipankarMukherjee, MD Vascular Surgery, Department of Surgery, Inova
Fairfax Hospital, Falls Church, VA, USA
Timothy J. Nypaver, MD Department of Surgery, Division of Vascular
Surgery, Henry Ford Hospital, Detroit, MI, USA
List of Invited Discussants
Himanshu J. Patel, MD Department of Cardiac Surgery, University of
Michigan Frankel Cardiovascular Center, Ann Arbor, MI, USA
IraklisI.Pipinos, MD Department of Surgery, Division of Vascular Surgery,
University of Nebraska Medical Center, Omaha, NE, USA
DanielJ.Reddy, MD, FACS, DFSVS Department of Surgery, Wayne State
University, Detroit, MI, USA
TimurP. Sarac, MD Department of Vascular Surgery, Aortic Center, The
Ohio State University School of Medicine, Columbus, OH, USA
JonathanR.Thompson, MD Department of Surgery, Division of Vascular
Surgery, University of Nebraska Medical Center, Omaha, NE, USA
S.KeisinWang, MD Department of Surgery, Division of Vascular Surgery,
Indiana University School of Medicine, Indianapolis, IN, USA
MitchellRoss Weaver, MD Department of Vascular Surgery, Henry Ford
Hospital, Detroit, MI, USA
Part I
Open Repair of Intact Abdominal
Aortic Aneurysm
Symptomatic Proximal
Anastomotic Pseudoaneurysm
ofSuprarenal Aorta
1
History
A 37-year-old white male was admitted to the
hospital on February 13, 1981, with the history of
low back pain and abdominal pain of 3-week
duration. This patient was rst seen January 1972
by an ophthalmologist with a 2-week history of
blurred vision. At that time his blood pressure
was found to be 240/140mm Hg, with grade IV
retinopathy. A comprehensive evaluation for
hypertension in 1972 was compatible with idiopathic malignant hypertension. Twenty-four-hour
urinary VMA was 9.2 (normal). Renal vein renin
assay was 4000ngE/hr in the right and 5900ngE/
hr. in the left (normal up to 275ngE/hr). An intravenous pyelogram revealed mild hydronephrosis
due to left ureteropelvic junction obstruction.
From 1972 until 1980, the patient’s blood pressure was well controlled. In May 1973, the patient
suffered right monoparesis involving the right
upper extremity and speech difculty, from
which he recovered in 3–6months. He has been
on propranolol 30 mgm q.i.d., hydrochlorothiazide 50mgm b.i.d., spironolactone 25mgm q.d.,
and guanethidine 10mgm q.d.
In September 1980, during the stress of his
father’s severe illness, the patient decided to discontinue his medication and later developed confusion and hallucinations. He was admitted to the
psychiatric service with probable diagnosis of
acute psychotic reaction.
Physical Examination
The patient’s height was 5′7″, with body weight
of 90 pounds. Examination of the heart showed
apex beat was outside the midclavicular line. The
lungs were unremarkable. Examination of the
abdomen revealed a large, pulsatile abdominal
aortic aneurysm, upper limit of which could be
reached with great difculty. He had excellent
femoral, popliteal, and pedal pulses.
Laboratory studies revealed hemoglobin
12.5 gm and a hematocrit of 37.8%, BUN
23mgm/dl, and creatinine 1.4mgm/dl.
Chest X-ray revealed cardiomegaly; EKG
showed evidence of left ventricular hypertrophy.
Ultrasound of the aorta revealed a large, abdominal aortic aneurysm with a transverse diameter of
10–12 cm. A retrograde aortogram performed
through the right femoral artery revealed large
abdominal aortic aneurysm, arising very close to
the origin of the renal arteries and abruptly
assuming its largest transverse diameter in its
proximal portion (Fig.1.1).
The patient was taken to the operating room
on February 22, 1981. A very large aortic aneurysm with focal, thinned-walled protrusions was
noted on the anterior wall (Fig. 1.2). The left
renal vein was mobilized, and left testicular vein
was ligated, and silastic vessel loop was passed
around the left renal vein. The proximal aortic
clamp was applied above the left renal vein but
© Springer Nature Switzerland AG 2020
S. S. Hans, Challenging Arterial Reconstructions, https://doi.org/10.1007/978-3-030-44135-7_1
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Fig. 1.1 Aortography showing large abdominal aortic
aneurysm
Fig. 1.2 Intraoperative picture of aneurysm
1 Symptomatic Proximal Anastomotic Pseudoaneurysm ofSuprarenal Aorta
Fig. 1.3 Operative specimen showing thrombus
just distal to the renal artery obliquely. Distal
control of the aneurysm was obtained at the common iliac artery level. The aneurysm was large,
10cm in diameter, and contained a large amount
of thrombus (Fig. 1.3). The aneurysm was
resected and reconstructed with an aorto-bi-iliac
graft (18 × 9 mm) woven Dacron. The patient
was discharged on postoperative day 7in satisfactory condition.
The patient was seen 13years later with back
pain that had been present for several weeks and
was admitted to the hospital where he underwent
a CTA.CTA showed normal-sized aorta from the
diaphragm down to the celiac and superior mesenteric arteries. The aorta then dilated up to a
lumen of around 10cm with a large anastomotic
false aneurysm. There was contrast in the right
renal artery but no contrast seen into the left renal
artery going into the left kidney. The aorto-biiliac graft that had previously been placed was
patent from below the aneurysm down to both
iliacs. There was a slight iliac enlargement distal
to the right limb of the aortoiliac graft. The arterial runoffs were normal.
Angiography showed a large juxtarenal
abdominal aortic aneurysm measuring
10cm×10cm in AP/transverse diameter. Right
renal artery begins adjacent to cephalad border of
aneurysm. The left renal artery likely originates
from the aneurysm, and there is a probably occlusion of the left renal artery. The aorto-bi-iliac
graft is patent.