A 68-year-old man was admitted to our clinic with abdominal pain. In his medical history, he has had chronic atrial fibrillation for 5 years and aortic valve replacement were applied 4 years ago. On physical examination, arterial blood pressure was 120/70 mmHg and peripheral pulses were weak in both lower limbs. The abdominal aortic aneurysm was detected on examination. Electrocardiography and transthoracic echocardiography were in normal limits. In abdominal computed tomography angiography, a aortic aneurysm, 2.5 cm below the left renal artery orifice extending to the aortic bifurcation, approximately 49×54 mm in the widest part at the infrarenal region, about 100 degrees angulation between normal aorta and aneurysmal section was detected. There was a aneurysmal dilatation, 61×63 mm in diameter, containing peripheral thrombus in the left iliac artery.
We decided to perform percutaneous endovascular aneurysm repair after this findings were detected. Pig tail catheter was advanced to descending aorta. Proximal neck of aortic aneurysm was significantly angled and tortuous. Digital subtraction angiography showed that aneurysm was in the infrarenal level (Figure 1). We could not proceed to aorta because of aneurysm. Then, snare was advanced from right brachial artery and wire on the left femoral artery was caught with snare aid. In order to reduce the endoleak in the left iliac artery, vascular plaque was placed to the left iliaca interna (Figure 6). Later, the left femoral approach was preferred as a main body and stent was advanced through stiff wire and 14 F sheath to cover the aneurysm neck to just below the renal arteries level, and image was taken again at his level. Stent was opened slightly at the infrarenal level to define optimal implantation place (Figure 1). Stent was opened fully after defining the optimal level (Figure 1). The aneurysm was completely closed and did not have any flow into. The extension stent was implanted to cover both iliac artery and left common iliac artery aneurysm (Figure 1). Procedure was terminated without any complication. Aneurysm in this patient began just distal to the left renal artery and was significantly angled and tortuous, additionally, aneurysm was extending to the left iliac region. In conclusion, aneurysm repair can be done safely in sharply angled iliac and abdominal aneurysms and in patients with high surgical risk. Vascular plaque should also placed to reduce the endoleak possibility.
