We presented a challenging case of a patient diagnosed with abdominal aortic aneurysm (AAA), peripheral artery disease, and chronic mesenteric ischemia (CMI). Herein, we describe the treatment in this high-risk patient diagnosed with CMI who also had critical limb ischemia and his AAA had rapidly expanded. First we performed angioplasty and celiac arterial stenting. Afterwards, we proceeded to perform balloon angioplasty of the iliac arteries and chimney endovascular aneurysm repair (Ch-EVAR) preserving the inferior mesenteric artery (IMA). The patient was discharged three days later and his IMA remained patent eighteen months post-operation. A thorough pre-operative assessment is essential in such challenging cases. Minimally invasive procedures like endovascular therapy and the chimney technique extend the prognoses in high-risk patients.
Aneurysm ; Angioplasty ; Angioplasty, Balloon ; Aortic Aneurysm, Abdominal ; Extremities ; Humans ; Iliac Artery ; Ischemia ; Mesenteric Artery, Inferior ; Mesenteric Ischemia ; Peripheral Arterial Disease ; Prognosis ; Stents

Aortocaval fistulas, typically linked to aortoiliac aneurysms, are rare vascular conditions. Currently, endovascular therapy is preferred treatment approach. However, endovascular therapy requires frequent and extended follow-up evaluations.Herein, we emphasize a noteworthy clinical finding in this disease: the presence of a pulsatile femoral vein. Additionally, we propose a novel, simple, and easily performed radiation-free method for postoperative assessment of fistula presence or resolution: duplex ultrasound of the femoral vein. While duplex ultrasound cannot substitute other diagnostic modalities, this technique offers a quick, cost-effective, and repeatable adjunct for monitoring.

Aortocaval fistulas, typically linked to aortoiliac aneurysms, are rare vascular conditions. Currently, endovascular therapy is preferred treatment approach. However, endovascular therapy requires frequent and extended follow-up evaluations.Herein, we emphasize a noteworthy clinical finding in this disease: the presence of a pulsatile femoral vein. Additionally, we propose a novel, simple, and easily performed radiation-free method for postoperative assessment of fistula presence or resolution: duplex ultrasound of the femoral vein. While duplex ultrasound cannot substitute other diagnostic modalities, this technique offers a quick, cost-effective, and repeatable adjunct for monitoring.

Aortocaval fistulas, typically linked to aortoiliac aneurysms, are rare vascular conditions. Currently, endovascular therapy is preferred treatment approach. However, endovascular therapy requires frequent and extended follow-up evaluations.Herein, we emphasize a noteworthy clinical finding in this disease: the presence of a pulsatile femoral vein. Additionally, we propose a novel, simple, and easily performed radiation-free method for postoperative assessment of fistula presence or resolution: duplex ultrasound of the femoral vein. While duplex ultrasound cannot substitute other diagnostic modalities, this technique offers a quick, cost-effective, and repeatable adjunct for monitoring.

Aortocaval fistulas, typically linked to aortoiliac aneurysms, are rare vascular conditions. Currently, endovascular therapy is preferred treatment approach. However, endovascular therapy requires frequent and extended follow-up evaluations.Herein, we emphasize a noteworthy clinical finding in this disease: the presence of a pulsatile femoral vein. Additionally, we propose a novel, simple, and easily performed radiation-free method for postoperative assessment of fistula presence or resolution: duplex ultrasound of the femoral vein. While duplex ultrasound cannot substitute other diagnostic modalities, this technique offers a quick, cost-effective, and repeatable adjunct for monitoring.

Aortocaval fistulas, typically linked to aortoiliac aneurysms, are rare vascular conditions. Currently, endovascular therapy is preferred treatment approach. However, endovascular therapy requires frequent and extended follow-up evaluations.Herein, we emphasize a noteworthy clinical finding in this disease: the presence of a pulsatile femoral vein. Additionally, we propose a novel, simple, and easily performed radiation-free method for postoperative assessment of fistula presence or resolution: duplex ultrasound of the femoral vein. While duplex ultrasound cannot substitute other diagnostic modalities, this technique offers a quick, cost-effective, and repeatable adjunct for monitoring.