Endovascular aneurysm repair with inferior mesenteric artery chimney in a high-risk patient with abdominal aortic aneurysm and iliac occlusion

A 63-year-old man presented for the treatment of abdominal aortic aneurysm in the setting of bilateral internal iliac artery compromise from prior peripheral arterial disease treatments. The inferior mesenteric artery (IMA) measured 5 mm. Patient underwent coronary artery stenting 6 months prior and experienced left leg claudication. He underwent endovascular aneurysm repair with chimney IMA grafting and a femorofemoral bypass with uneventful recovery. At 1 year, computed tomography angiogram shows no flow in the aneurysm sac, and his left leg claudication resolved. Endovascular aneurysm repair with chimney IMA grafting for colonic perfusion preservation is a reasonable alternative to open surgical repair with IMA reimplantation in high-risk patients.