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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE

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Gazzetta Medica Italiana Archivio per le Scienze Mediche 2012 June;171(3):357-9

Copyright © 2012 EDIZIONI MINERVA MEDICA

language: English

Use of Zenith iliac plug to occlude an artificial graft during endovascular repair of an abdominal aortic aneurysm

Yamamoto K. 1, Aramoto H. 1, Asano R. 2, Yoshida T. 2, Yamada M. 3, Takanashi S. 3

1 Department of Vascular Surgery, Sakakibara Heart Institute, Japan Research Promotion Society for Cardiovascular Diseases, Fuchu, Tokyo, Japan; 2 Department of Cardiology, Sakakibara Heart Institute, Japan Research Promotion Society for Cardiovascular Diseases, Fuchu, Tokyo, Japan; 3 Department of Cardiovascular Surgery, Sakakibara Heart Institute, Japan Research Promotion Society for Cardiovascular Diseases, Fuchu, Tokyo, Japan


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We report a case of 60-year old man with abdominal aortic aneurysm who has also undergone aorto-left-iliac bypass surgery twenty years before. We decided to take an endovascular approach because the patient’s abdomen had been opened twice, and he had undergone coronary bypass surgery only a few months before the admission. The main body of the Zenith AAA endovascular graft (Cook Medical Inc., Bloomington, IN, USA) was inserted, followed by a Zenith aortic converter to block antegrade blood flow into the contralateral arm. Zenith iliac plug was then inserted from the left and placed within the bypass graft. We finally performed a crossover bypass between the bilateral external iliac arteries. Generally, when a type 2 endoleak occurs after endovascular repair, an artery with a backflow is usually left to occlude over time. In this case, 10-mm bypass graft was likely to be the source of the type 2 endoleak. The risk of not occluding, was thought to be high because this graft was much larger than the arteries such as lumbar and inferior mesentric arteries. In order to occlude this flow, Zenith iliac plug, which is usually placed in a native iliac artery, was placed in an artificial bypass graft. This was successfully performed with no endoleaks of any type.

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