Nuevas opciones de embolización de aneurisma aortoilíaco asociado a aneurisma de hipogástrica. A propósito de un caso

Introduction. The treatment of aortoiliac aneurysms associated to aneurysms in the hypogastric artery is a challenge for vascular surgeons, who have to devise tailor-made tactics to fit the anatomy ofeach case. Case report. A 78-year-old ex-smoking male, with a history of arterial hypertension, ischaemic heart disease and two strokes, who was being followed up due lo an aortoiliac aneurysm that reached the surgical range; the decisión was made to carry out endovascular repair. The abdominal aortic aneurysm measured 40 mm ancl was associated to an aneurysm in the left common iliac and left hypogastric arteries, with diameters of 30 and 40 mm respectively. A contralateral approach was employed to implant a 22 × 18 mm Amplatzer Vascular Plug occluder, from the neck of the aneurysm in the left hypogastric lo the bifurca!ion of the common iliac artery, which resulted in exclusión ofboth aneurysms. A 26 × 14 × 155 mm Talent-type right aortomonoiliac stent was placed, together with a right-left crossed femorofemoral 8-mm Dacron bypass. In the post-operative arteriography, the stent isfound to be patenl, the re is a type II endoleak due lo an aortic aneurysm near the lumbar región and the aneurysm of the hypogastric artery is thrombosed. A tomography angiography sean al one year shows pateney of the stent and the bypass, exclusión of the aneurysms in the aortoiliac and the hypogastric arteries, absence ofendoleaks and no change in the size of the aneurysmal sacs. Conclusions. The design of new devices that are precise and simple to release, as well as being more flexible, allows for new strategies in the treatment ofeomplex aneurysms that compromise the aortoiliac artery. The Amplatzer Vascular Plug occluders make it possible lo occlude the common iliac and seal the osliuni of the hypogastric artery in one single procedure and with just one single device. [ANGIOLOGÍA 2009; 61: 275-8]