Acute leg ischemia and huge AAA diagnosed during inguinal hernia surgery

Watch this case to assess the most appropriate treatment, taking into account the presentation of two acute arterial pathologies at the same time: ischemia of both legs and symptomatic aortic aneurysm with distal embolization.

Gregorio Marañón Hospital, Madrid, Spain
Part I - Case presentation

An 81-year-old male patient with history of:

  • Myocardial infarction in 2022 and left ventricular ejection fraction < 30 %
  • Left ventricular thrombus (Rivaroxaban)

He presented with signs of acute Rutherford IIa ischemia in the right leg during surgery for a right groin hernia, with no pulse, and a decreased pulse in the other leg.

Complete CT in emergency room
Sizing CT
3D Reconstruction

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Part II - Treatment

The recommended solution was hybrid endovascular AAA repair and bilateral embolectomy

  • Heparin insertion and bilateral open transfemoral embolectomy  
  • In the hybrid theater, we put a 28.5 mm Gore C3 conformable endograft ending into the right external iliac artery and the left common iliac artery. We end in external iliac in the right size: 16 x 10 mm, and, in the left, we finished in 23 mm in the common iliac.
  • After deploying the graft, we needed to place a cuff because of the neck angulation and proximal endoleak.
Residual thrombus after embolectomy
Gore C3 conformable graft
IA endoleak because of the neck angle (65º)
Final angio after proximal cuff completion

Post Op

  • Discharge at 3rd day without complications, and with distal pulses
  • CT scan showed no endoleaks (1 month)
1 month CT
3D reconstruction