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Vascular illustration. (A) Aorto-bifemoral repair with bifurcated Hemashield graft, Maquet  (gray) for infrarenal abdominal aortic aneurysm, bilateral common and bilateral internal iliac aneurysms. (B) Left iliac graft occlusion due to extrinsic compression from massively dilated left sided aneurysm from late retrograde collateral flow from right trans pelvic collaterals (asterix) and branches of left profunda femoris artery (arrows).
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Emergent aortogram revealed left iliac graft occlusion and stenosis of the left graft limb femoral anastomosis, as well as late retrograde collateral blood flow to the aneurysm coming from trans pelvic collaterals and branches of left profunda femoris artery (Figure 1B).
Computed tomography abdomen with contrast. (A) Axial view showing massive bilateral (left greater than right) saccular aneurysmatic dilation (asterisk) of prior infrarenal aortic aneurysm. (B) Coronal view showing massive saccular aneurysmatic dilation within the pelvis encasing the aorta and mass effect into left iliac arterial vascular system (arrow).
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Computed tomography (CT) of the abdomen and pelvis with contrast (Figure 2A,2B) showed large cystic lesions within the pelvis encasing the aorta related to aneurysm dilatations of the iliac arteries.
PMC9343974_03
Vascular illustration. (A) Aorto-bifemoral repair with bifurcated Hemashield graft, Maquet  (gray) for infrarenal abdominal aortic aneurysm, bilateral common and bilateral internal iliac aneurysms. (B) Left iliac graft occlusion due to extrinsic compression from massively dilated left sided aneurysm from late retrograde collateral flow from right trans pelvic collaterals (asterix) and branches of left profunda femoris artery (arrows).
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Emergent aortogram revealed left iliac graft occlusion and stenosis of the left graft limb femoral anastomosis, as well as late retrograde collateral blood flow to the aneurysm coming from trans pelvic collaterals and branches of left profunda femoris artery (Figure 1B).
Aortogram. (A) Total occlusion of left hemi-pelvis arterial system originating at aortic bifurcation (arrow). (B) Complete revascularization of left hemi-pelvis arterial system after successful angioplasty and thrombectomy (arrowheads).
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He underwent left femoral artery thrombectomy, bilateral graft limb stent placement and left femoral graft anastomosis balloon angioplasty and stent placement with restoration of blood flow to the left lower extremity (Figure 3).
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