Narrow distal aorta (NDA) makes endovascular aortic repair (EVAR) challenging and prone to immediate and late complications. We describe a case of an abdominal aortic false aneurysm (AAFA) with a NDA and iliac occlusive disease that was treated by an iliac branch device (IBD) placed at the aortic bifurcation.
A 76-year-old male patient suffering from severe bilateral calf claudication presented to our clinic. He had a history of ischemic heart disease, diabetes mellitus and left colectomy for colon cancer. His workup revealed an AAFA with severe iliac occlusive disease. His aortic lumen and his aortic bifurcation were very narrow (10 mm) precluding a classic bifurcated EVAR. An open repair was not possible neither because of his multiple comorbidities. We successfully used an IBD by placing its Y configuration at the level of the aortic bifurcation, bridging the branch into one iliac artery with a balloon expandable covered stent and extending the main component proximally up to the renal arteries with an aortic cuff.
Bifurcated EVAR may not be suitable in patients with NDA. Using an IBD at the level of the aortic bifurcation is feasible. This technique offers a total endovascular solution in high-risk patients for open repair.

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