Bilateral leg ischemia due to descending aortic dissection: combined treatment with femoro-femoral cross-over bypass and unilateral aorto-iliac stenting.
We report a case of aorto-iliac occlusion due to descending aortic dissection treated initially with femoro-femoral cross-over bypass and secondarily with unilateral aorto-iliac stenting because of progression of the dissection. A 75-year-old man presented with acute ischemia of the right leg. CT revealed occlusion of the right iliac artery due to descending aortic dissection with a clotted false lumen. Three days after femoro-femoral cross-over bypass, ischemia of both legs developed and angiography demonstrated occlusion of the infrarenal aorta and left common iliac artery. Two overlapping stents were deployed in these vessel segments. Completion angiography confirmed successful recanalization with adequate distal flow and good patency of the cross-over bypass. Peripheral pulses were restored and the patient's symptoms were alleviated. Combined treatment with cross-over bypass and endovascular recanalization may be considered as a viable alternative to open aortic surgery in selected cases of complicated aorto-iliac dissection with bilateral leg ischemia.
Frahm
Christian
C
Department of Diagnostic Radiology, University Hospital Kiel, Arnold-Heller-Strasse 9, D-24105 Kiel, Germany. christian.frahm@rad.uni-kiel.de
Widmer
Matthias K
MK
Brossmann
Joachim
J
Do
Dai-Do
DD
D000368:Aged; D000784:Aortic Dissection / Q000150:complications*; D000800:Angioplasty, Balloon; D001013:Aorta, Thoracic / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000150:complications*; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000628:therapy; D003131:Combined Modality Therapy; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D007511:Ischemia / Q000209:etiology* / Q000601:surgery / Q000628:therapy*; D007866:Leg / Q000098:blood supply* / Q000601:surgery; D008297:Male; D015607:Stents