PMC6543130_01
Axial CT slices of the abdominal aortic (A), left (B), and right common iliac (C) aneurysms pre-operatively, where maximum diameters are displayed.
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A 67 year old male patient presented with an infrarenal aorto-iliac aneurysm with a maximum aortic diameter of 42 mm, a left common iliac diameter of 36 mm, and right common iliac diameter of 35mm (Fig. 1).
Completion intra-operative angiography showing good positioning of the endograft, occluded right internal iliac artery, and patent left internal iliac artery, with no evidence of an endoleak.
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Next, a percutaneous EVAR procedure was performed, under local anaesthesia and conscious sedation, with the Ovation iX endograft (Endologix, Irvine, CA, USA) (main body 29x80 mm, right iliac limb 28x100 mm with a 14x160 mm extension to the right external iliac and left iliac limb 22x100 mm landing just prior to the left iliac bifurcation) (Fig. 2).
Axial CT image (A) and multiplanar reconstruction (B) post-operatively. The distal sealing zone at the level of the left iliac bifurcation can be seen.
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Urgent CT angiography showed a patent endograft with good positioning and successful exclusion of the aneurysm with no signs of an endoleak (Fig. 3).
Ultrasonography using colour Doppler. The left testis appeared inhomogeneous and oedematous. The absence of blood flow is noted representing infarct/necrosis.
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Initial ultrasonography using a conventional grey scale and colour Doppler, revealed an enlarged, inhomogeneous left testis with the absence of flow on colour Doppler examination and architecture distortion, representing infarct/necrosis (Fig. 4).
Ultrasonography using power Doppler performed at the two month follow up visit. Repeat ultrasound confirmed the absence of blood flow consistent with the original infarction.
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Repeat ultrasound confirmed the absence of flow in the affected testicle, as shown with the power Doppler image (Fig. 5).
Pre-operative CT angiography displaying a patent testicular artery on the left side (white arrow). The size of the testicular artery is 3 mm.
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