E-ISSN 1658-7820
 

Case Report 


Hybrid Revascularization of Infrarenal Aortic Occlusion due to Thrombophilia: A Case Report

Yazeed Alofisan, Thomas M Warburton, Ahmed Alhumaid, Nedal Katib, Shannon D Thomas.


Abstract
Background: Infrarenal abdominal aortic occlusive disease has traditionally been treated with aortic endarterectomy, aortobifemoral bypass grafting, or both; however, it has also been associated with up to a 3.3% to 4.6% perioperative mortality rate and an 8.3% to 13.1% major early complication rate. European Guidelines on Peripheral Artery Diseases published in 2017 support a hybrid approach. Thrombophilia is a commonly overlooked cause of peripheral arterial disease (PAD) in younger patients. Thrombophilia is reported to lead to an increased incidence of graft failure and multiple revascularization procedures. This presented a rare case highlighting the surgical approach to complex aortoiliac occlusion due to thrombophilia with subsequent lower limb ischemia and the multi-disciplinary input needed in this vulnerable patient cohort.
Case presentation: Herein, we present a case of an acute distal aortic occlusion and failed revascularization with a history of thrombophilia and previous left leg below-knee-amputation (BKA) due to acute limb ischemia. He had a background of recently withholding warfarin for a ureteric stent insertion for renal calculus. The diagnosis of our case depended on CT and angiography, where they confirmed an occluded infrarenal aorta with bilaterally occluded common and external iliac arteries. Our case underwent hybrid revascularisation under bivalirudin cover. An open thrombectomy of the right common femoral artery (CFA) and PFA was performed. A left brachial artery cutdown was performed, and a catheter was placed in the suprarenal abdominal aorta. The right iliac artery occlusion was crossed from the left brachial access with a Command 0.018 wire supported by a Van Schie II catheter with a through-and-through wire able to be retrieved from the open right CFA. The proximal IMA was stented with a 6 x 80mm Absolute Pro-self-expanding stent, deployed in a kissing-stent fashion with a 10 x 100mm Absolute Pro stent in the distal aorta. Overlapping self-expanding stents were deployed from the distal aorta to the right external iliac. Six weeks after the procedures, computed tomography/angiography confirmed the excellent radiologic results.
Conclusion: This rare case highlights the catastrophic outcomes that can happen when anticoagulation is withheld in thrombophilic patients. It exhibits the Role of a hybrid open and endovascular approach in complex occlusive aortoiliac disease and the critical importance of early multi-disciplinary involvement in critically unwell patients.

Key words: Hybrid Revascularization, Infrarenal Aortic Occlusion, Thrombophilia


 
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How to Cite this Article
Pubmed Style

Alofisan Y, Warburton TM, Alhumaid A, Katib N, Thomas SD. Hybrid Revascularization of Infrarenal Aortic Occlusion due to Thrombophilia: A Case Report. IJMDC. 2023; 7(12): 2021-2025. doi:10.24911/IJMDC.51-1697579461


Web Style

Alofisan Y, Warburton TM, Alhumaid A, Katib N, Thomas SD. Hybrid Revascularization of Infrarenal Aortic Occlusion due to Thrombophilia: A Case Report. https://www.ijmdc.com/?mno=173487 [Access: March 26, 2024]. doi:10.24911/IJMDC.51-1697579461


AMA (American Medical Association) Style

Alofisan Y, Warburton TM, Alhumaid A, Katib N, Thomas SD. Hybrid Revascularization of Infrarenal Aortic Occlusion due to Thrombophilia: A Case Report. IJMDC. 2023; 7(12): 2021-2025. doi:10.24911/IJMDC.51-1697579461



Vancouver/ICMJE Style

Alofisan Y, Warburton TM, Alhumaid A, Katib N, Thomas SD. Hybrid Revascularization of Infrarenal Aortic Occlusion due to Thrombophilia: A Case Report. IJMDC. (2023), [cited March 26, 2024]; 7(12): 2021-2025. doi:10.24911/IJMDC.51-1697579461



Harvard Style

Alofisan, Y., Warburton, . T. M., Alhumaid, . A., Katib, . N. & Thomas, . S. D. (2023) Hybrid Revascularization of Infrarenal Aortic Occlusion due to Thrombophilia: A Case Report. IJMDC, 7 (12), 2021-2025. doi:10.24911/IJMDC.51-1697579461



Turabian Style

Alofisan, Yazeed, Thomas M Warburton, Ahmed Alhumaid, Nedal Katib, and Shannon D Thomas. 2023. Hybrid Revascularization of Infrarenal Aortic Occlusion due to Thrombophilia: A Case Report. International Journal of Medicine in Developing Countries, 7 (12), 2021-2025. doi:10.24911/IJMDC.51-1697579461



Chicago Style

Alofisan, Yazeed, Thomas M Warburton, Ahmed Alhumaid, Nedal Katib, and Shannon D Thomas. "Hybrid Revascularization of Infrarenal Aortic Occlusion due to Thrombophilia: A Case Report." International Journal of Medicine in Developing Countries 7 (2023), 2021-2025. doi:10.24911/IJMDC.51-1697579461



MLA (The Modern Language Association) Style

Alofisan, Yazeed, Thomas M Warburton, Ahmed Alhumaid, Nedal Katib, and Shannon D Thomas. "Hybrid Revascularization of Infrarenal Aortic Occlusion due to Thrombophilia: A Case Report." International Journal of Medicine in Developing Countries 7.12 (2023), 2021-2025. Print. doi:10.24911/IJMDC.51-1697579461



APA (American Psychological Association) Style

Alofisan, Y., Warburton, . T. M., Alhumaid, . A., Katib, . N. & Thomas, . S. D. (2023) Hybrid Revascularization of Infrarenal Aortic Occlusion due to Thrombophilia: A Case Report. International Journal of Medicine in Developing Countries, 7 (12), 2021-2025. doi:10.24911/IJMDC.51-1697579461





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