Late Complete Endograft Occlusion After Endovascular Aneurysm Repair Successfully Treated With Unilateral Endograft Relining and Femoro-femoral Bypass: A Case Report.

Complete endograft occlusion involving the main body and both limbs after endovascular aneurysm repair (EVAR) is rare, and the optimal treatment remains unclear. We report an 85-year-old male with late complete endograft occlusion after EVAR for an abdominal aortic aneurysm. Computed tomography (CT) showed complete thrombotic occlusion extending from just below the renal arteries to both iliac limbs and distally to the level of the external iliac arteries. A hybrid procedure was performed. After proximal recanalization under right renal artery protection, thrombectomy was performed through the left groin. Next, unilateral endograft relining was carried out using Ovation iX limbs, followed by femoro-femoral bypass. Postoperative CT confirmed patency of the relined limb, femoro-femoral bypass, and left external iliac artery reconstruction, with preserved bilateral renal perfusion. The ankle-brachial index improved from 0.58/0.49 to 0.95/0.88. Hybrid revascularization based on unilateral inflow reconstruction may be an effective option for selected patients with this rare complication.