Aortoprofunda and internal iliac bypass in open repair of abdominal aortic aneurysm with aortoiliac occlusive disease

An 83-year-old man with prior coronary bypass and iliac stenting presented with bilateral claudication. Ankle-brachial indices were immeasurable. Computed tomography revealed an infrarenal abdominal aortic aneurysm and bilateral iliac occlusion with severe calcification, while runoff depended on profunda femoris collaterals. Open repair was performed with infrarenal aortic replacement using a three-branched graft to the right internal iliac and bilateral profunda femoris arteries. Postoperatively, ankle-brachial indices improved to 0.58/0.57, imaging confirmed graft patency, and symptoms resolved. This case highlights profunda femoris and internal iliac arteries as effective outflow targets when conventional aortobifemoral bypass is not feasible.