Successful Endovascular Repair of a Narrow-Ruptured Aorta With an Iliac Branch Device: Case Report and Literature Review

A 47-year-old man with a history of drug addiction sustained an aortic rupture with a clinical status of shock and sepsis. An open repair was not possible because of his unstable hemodynamics, the suspicion of an infected aorta and a very hostile abdomen. However, the endovascular approach would have been very challenging due to a very narrow infrarenal aorta. A Gore iliac branch endoprosthesis was successfully deployed as a bifurcated aortic stent graft and the aortic rupture was completely excluded. The patient was discharged after 20 days with long-term antibiotic and antifungal therapy. No signs of migration or limb occlusion at 6 months computed tomography scan were detected. This off-label use of an iliac branch device (IBD) with a precannulated gate appears to be a good solution in emergency repair of a very narrow ruptured aorta.Clinical ImpactWe report the case of an iliac branch endoprosthesis used as a bifurcated aortic stent graft in a very narrow ruptured infrarenal aorta. The report describes a new approach that can be useful in emergencies to deal with aortic ruptures when a narrowed lumen forbids the use of a standard endograft.