ENDOVASCULAR TREATMENT OF ABDOMINAL AORTIC ANEURYSM INVOLVING THE INTERNAL ILIAC ARTERIES USING THE EVAR METHOD - CLINICAL CASE

Introduction. Throughout the last decade, EVAR (EndoVascular Aneurism Repair), became the treatment of choice for treatment of abdominal aortic aneurism. Perioperative morbidity and mortality, as well as the inhospital stay are reduced due to the minimally invasive aspect of the procedure. In cases of hypogastric artery involvement in the aneurismatic process, these being seen in 20% of cases, EVAR limb extensions to the external iliac arteries are needed. Uni- or bilateral hypogastric artery embolisation prevent type II endoleak, due to back flow from the hypogastric artery. Case presentation. Hereby we report the first successful case of staged bilateral hypogastric artery embolisation and EVAR in the Republic of Moldova. A 72 y/o patient was diagnosed with Abdominal aortic aneurism involving bilateral common and hypogastric arteries. The diagnosis was confirmed by contrast CT. The decision was to preembolize the hypogastric arteries in two stages, one month from another, giving time for collateral bed development, for prevention of pelvic ischemia, which can be seen in up to 55% cases. The EVAR procedure underwent with bilateral limb extensions to the external iliac arteries. At angiographic control there were no signs of endoleaks, and no aneurism sac enhancement. At 3 month follow-up there were no endoleaks, and the aneurism sac was shrinked without contrast. Conclusions. Aortic aneurisms involving hypogastric arteries can be successfully treated by combining EVAR with hypogastric artery trunk embolisation, for prevention of type II endoleaks. Bilateral hypogastric artery involvement needs thorough individual planning, taking in consideration collateral bed anatomy