Ivo Petrov, L.Grozdinski, M.Pavlova

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Ivo Petrov, L.Grozdinski, M.Pavlova Endovascular treatment of occluded abdominal aortic aneurysm /Lerishe’s syndrome/ Ivo Petrov, L.Grozdinski, M.Pavlova

RELEVANT HISTORY AND PHYSICAL EXAM: 60 year old male with Lerishe’s syndrome presenting with intermittent claudication in both legs when walking 100 meters Comorbidity: Pancreatic tuomr formation Coronary artery disease. PCI and stenting in LCx and D1, 2 months ago Ischemic stroke in the reagon of the left middle cerebry artery 1 year ago. Arterial hypertension III gr. Dyslipidemia. Pneumofibrosis. Lack of palpations in femoral, popliteal and tibial arteries for both legs.

Echo Doppler And Doppler Sonography: Relevant Findings Echo Doppler And Doppler Sonography: Carotid arteries- innitial atherosclerotic changes Occluded abdominal aortic aneurysm below the renal arteries. Thrombosis of both iliac arteries. Doppler sonography of the tibial aretries: A.brachialis dex-150 mmHg; a.brachialis sin 140 mmHg ATA dex -60 mmHg ATP dex -0 ABI dex-0.4 ATA sin-60mmHg ATP sin-0 ABI sin-0.4

Angiography: Relevant findings Occluded abdominal aortic aneurysm below the renal arteries. Thrombosis of both iliac arteries. Passable stents in LCx and D1

Diagnostic

Interventional management Right brachial access; 6Fr Aortography: Occlusion of the abdominal aortic aneurysm and iliac arteries. Leaderboard 0.14 'Miracle 12 penetrate the occlusion . Predilatation with OTW balloon 4/80mm. Two stent implantation Protégé 7/150mm and 12/80 mm in the abdominal aorta and right iliac artery. Postdilatation with balloon 8/100 mm. Excellent angiographic result. In the absence of improvement, the patient should be directed to the FEM-FEM crossover bypass / right-left

Final Result

Control CT

Control Echo Doppler Abdominal aorta and right external iliac artery

Control Echo Doppler

Thrombosis in the left external iliac artery

Control Doppler sonography: Doppler sonography of the tibial aretries: A.brachialis dex-160 mmHg; ATA dex -160 mmHg ATP dex -160 ABI dex-1.0 ATA sin-70mmHg ATP sin-70 ABI sin-0.43 Improvement in claudication!

Conclusion: In this case due to unclear pancreatic Tu formation we decided to perform endovascular revascularization to open surgery. Endovascular therapy can be an alternative to open surgery in patient with relative contraindications.