Complex aortoiliac occlusions

A 72-year-old male patient with a history of aorto bi-iliac prosthesis for bilateral iliac occlusion presented with an occlusion of the surgical prosthesis. Symptoms included chronic ulcers and rest pain. Several treatment options were discussed, including thrombolysis, endovascular treatment, and open surgery.

Ozan Yazar

Zuyderland Medical Center, Heerlen, Netherlands

Pieter B. Salemans

Zuyderland Medical Center, Heerlen, Netherlands

Ine Rochus

Zuyderland Medical Center, Heerlen, Netherlands

Lee Bouwman

Zuyderland Medical Center, Heerlen, Netherlands

Part I - Case presentation

The patient was a 72-year-old man

Comorbidities: hyperlipidemia and hypertension
2010: prostate cancer → hormone therapy + radiation therapy
2011: rectal cancer → laparotomy, rectum amputation + terminal colostomy
29.04.2015: Rutherford III → kissing stents CIA
21.05.2015: occlusion stents CIA → recanalisation failure
24.06.2015: surgical aorto bi-iliac prosthesis

On 27/09/2022, the patient presented with acute bilateral claudication (Rutherford III) and a walking distance of 90 meters, leading to a CT angioscan being performed.

Here are the images from the CT angioscan: can you tell us what you see?

After explaining the different options to the patient and their risks, the decision was made to opt for conservative therapy.
The patient was admitted and placed under observation, receiving heparin.
He was then discharged home after 2 days with anti-platelet medication.
Supervised walking therapy was then provided.

On 10 December 2022, the patient presented again with rest pain and ischaemic wounds.

ABI	right 0.16	left 0.13
TP	right 27 mmHg	left 0 mmHg

Rutherford V – bilateral ischemic ulcers and worsening clinical status
Multidisciplinary meeting