PMC6497112_01
Lumbar Spine MRI: (A) sagittal T2WI showing degenerative disc changes with significant thecal sac compression at levels L5-S1, Magnification X1 (B) axial T2W at levels L4-L5 showing a massive AAA, Magnification X2.. Abbreviations: AAA, Abdominal Aortic Aneurysm; MRI, Magantic Resonance Imaging.
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The MRI also revealed multiple degenerative intervertebral disc bulges in the L2-S1 segments, with significant secondary spinal canal stenosis (Figure 1).
Preoperative CTA: (A) axial view showing a thick-walled 10 cm infrarenal AAA, Magnification x1(B and C) Axial (Magnification X1) and coronal (Magnification X2) views showing an aneurysmal extension into to right IIA.. Abbreviations: AAA, Abdominal Aortic Aneurysm; CTA, Computed Tomography Angiography.
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He was found to have a favorable aortic neck anatomy, and a sufficient landing zone (Figure 2).
Intraoperative digital subtraction angiogram: (A) large infrarenal AAA with aneurysmal dilatation of right common iliac artery and short ectatic left common iliac artery, Magnification X1(B) successful deployment of the bifurcated graft and embolization of RIIA, Magnification X1.. Abbreviations: AAA, Abdominal Aortic Aneurysm; RIIA, Right Internal Iliac Artery.
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We selectively embolized the right internal iliac artery, and intentionally covered both internal iliac arteries due to the features seen on the CTA (Figure 3).
Follow-up CTA showing: (A) patent graft with exclusion of the aneurysm from circulation and without endoleak, Magnification X1. (B) Retrograde flow into RIIA, Magnification X1.. Abbreviations: CTA, Computed Tomography Angiography; RIIA, Right Internal Iliac Artery
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Furthermore, a CTA 4-week postoperation showed complete exclusion of the aneurysm without endoleak, as well as maintenance of pelvic perfusion via retrograde flow from the left internal iliac artery (Figure 4).
Ischemic colitis changes seen on a rectal biopsy. Magnification X4
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An urgent colonoscopy revealed mild inflammation in the rectum, with a biopsy showing features of ischemic colitis (Figure 5).