Reconstruction of the internal iliac artery in patients with aneurysmal disease: Two case reports

During the endovascular repair of aortoiliac aneurysm, bilateral internal iliac artery (IIA) occlusion may give rise to significant morbidities such as ischemia of buttock or sigmoid colon and erectile dysfunction. Open and endovascular approaches are used to maintain IIA circulation in such cases. The present report describes the cases of two patients who underwent external-to-internal iliac artery bypass surgery, one via a novel hybrid approach. The first patient had a right common iliac artery aneurysm without a sufficient distal landing zone for endovascular repair. The distal landing of the device was therefore placed in the right external iliac artery (EIA). The tortuous portion of the right EIA was excised and anastomosed in an end-to-end fashion. An external-to-internal iliac artery bypass was then performed. The second patient underwent endovascular repair of the IIA aneurysm with a Gore® Viabahn®-covered stent (W. L. Gore and Associates, Inc., Flagstaff, AZ, USA). This covered stent was anastomosed with the iliac bypass graft. Postoperative pelvic circulation was maintained. In conclusion, this strategy for maintaining IIA flow is a potential novel approach for future use.