Endovascular Management of an Infrarenal Abdominal Aortic Aneurysm With Severe Tortuosity of the Left Common Iliac Artery: A Case Report

Abdominal aortic aneurysms (AAA) require careful management. Endovascular aneurysm repair (EVAR) is a less invasive alternative to open surgery, but complex aneurysms involving challenging iliac artery anatomy may require advanced procedures. A 72-year-old man presented with a symptomatic infrarenal AAA and a severe tortuosity of the left common iliac artery. Due to this unfavorable anatomy, a complex EVAR approach was undertaken. This involved occlusion of the left common iliac artery using an Amplatzer Vascular Plug II (Abbott Laboratories, Abbott Park, IL), followed by deployment of an aorto-uni-iliac EVAR stent graft via the right femoral artery. To maintain left lower extremity perfusion, a femoral-femoral crossover bypass graft was created. The patient recovered without complications. This case demonstrates the feasibility and effectiveness of complex EVAR techniques in managing challenging aortic aneurysms, emphasizing the need for careful patient selection, meticulous technique, and close follow-up to ensure successful outcomes.