Internal Iliac Artery Revascularization for Limb Salvage Purposes

Homayoun Hashemi, MD, Alaa Alhazmi, MD, Paul S. Massimiano, MD and Dipankar Mukherjee, MD
Inova Fairfax Hospital, Falls Church, VA and Inova Fairfax Hospital General Surgery Residency Program, Falls Church, VA

Objective: To demonstrate that internal iliac revascularization can be an adequatetreatment for limb salvage in a patient with completely occluded iliofemoral and popliteal arteries who underwent multiple
revascularization procedures that failed.
Method: Case report analysis of a patient with who had undergone aorto-bifemoral bypass, followed by three failed right lower extremity bypasses and three percutaneous translational angioplasties over the course of 14 years, and eventually developed limb threatening ischemia.
Results: Angiography showed occluded right limb of aorto-bifemoral bypass graft, total occlusion of the right iliac system including the proximal internal iliac artery. Also, it showed total occlusion of the
common femoral artery and the main branches of profunda femoris and popliteal arteries with reconstitution of tibial vessels. Right internal iliac endarterectomy combined with aorto- right internal iliac bypass was
performed. The patient's ischemic rest pain completely resolved postoperatively with subsequent healing of the ulcers in two months. A follow-up angiogram demonstrated patency of the graft and excellent flow
through the collaterals.
Conclusions: Patients with limb threatening ischemia and lack of appropriate inflow target vessels may benefit from internal iliac endarterectomy with aorto-iliac revascularization.