• Takafumi Akai, Takanori Kaneko, and Takatoshi Furuya.
• Department of Vascular Surgery, Asahi General Hospital, Chiba, Japan.
• Medicine (Baltimore). 2024 Apr 5; 103 (14): e37731e37731.

RationaleA hostile iliac access route is an important consideration when enforcing endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA). Herein, we report a case of AAA with unilateral external iliac artery occlusion, for which bifurcated EVAR was successfully performed using a single femoral and brachial artery access.Patient ConcernsA 76-year-old man who had undergone surgery for lung cancer 4.5 years prior was diagnosed AAA by computed tomography (CT).DiagnosisTwo and a half years before presentation, CT revealed an infrarenal 48 mm AAA, which had enlarged to 57 mm by 2 months preoperatively. CT identified occlusion from the right external iliac artery to the right common femoral artery, with no observed ischemic symptoms in his right leg. The right external iliac artery, occluded and atrophied, had a 1 to 2 mm diameter.InterventionSurgery was commenced with the selection of a Zenith endovascular graft (Cook Medical) with an extended body length. Two Gore Viabahn VBX balloon expandable endoprosthesis (VBX; W.L. Gore & Associate) were delivered from the right axilla as the contralateral leg.OutcomesCT scan on the 2nd day after surgery revealed no endoleaks.LessonsWhile the long-term results remain uncertain, this method may serve as an option for EVAR in patients with unilateral external iliac artery occlusion.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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