Emergent endovascular aortic repair using the double D technique for ruptured isolated common iliac artery aneurysm

Abstract

Background: The double D technique (DDT) is a method of parallel placement of the left and right legs of the same diameter in patients with anatomically incompatible commercially available bifurcated stent grafts in endovascular aortic repair (EVAR). It is indicated for cases such as aortic dissection and isolated common iliac aneurysm, in which the working space is small when inserting the lateral leg and contralateral gate insertion is difficult. Herein, we report a case in which EVAR with DDT was used to treat a ruptured isolated common iliac aneurysm with a narrow terminal aorta. Case: A 46-year-old man was transferred to the emergency room because of loss of consciousness. On arrival, he was in shock (systolic blood pressure: 48 mmHg; heart rate: 112 bpm). Contrast-enhanced computed tomography supported a diagnosis of ruptured right common iliac artery aneurysm and underwent emergency EVAR. The distance from the aortic bifurcation to the right common iliac artery aneurysm was 10 mm, and hemostasis was expected to be difficult with unilateral leg placement. Additionally, the terminal aortic diameter was 17 mm, and a bifurcated device that could be used in an emergency could not be applied. Therefore, EVAR (Excluder) with DDT was performed. The patient was discharged home on postoperative day 7. The patient had no endoleaks 6 months postoperatively. Conclusion: EVAR is the first choice for ruptured abdominal aortic aneurysms and common iliac aneurysms because of its minimal invasiveness and rapidity, if the anatomical requirements are met. Using DDT, EVAR can be performed in emergencies in patients with anatomical restrictions, such as those with a narrow terminal aorta, thus enabling minimally invasive and rapid treatment.

Keywords

• Abdominal aortic aneurysm
• Double d technique
• Excluder