A 75-year-old man presented with an asymptomatic abdominal aortic aneurysm that had been initially discovered on a CT scan five years previously. The CT had been done in conjunction with an evaluation for prostate cancer that had been discovered in 1988 and for which he had undergone operative resection. The aneurysm was 3.4 cm in diameter when first discovered, and had grown to 6 cm in diameter on the most recent CT. There had been no evidence of recurrence of the prostate cancer and the patient had no symptoms referable to the aneurysm, such as back or abdominal pain.

Significant in his medical history was the prostate cancer, for which he underwent radical prostatectomy, chemotherapy and radiation therapy. He had been taking medication for hypertension for five years, but had no other chronic illnesses.

On examination, he was a thin, well-appearing male. The aneurysm was palpable as a pulsating mass in the middle of the abdomen. Pulses in both legs were normal.

A repeat CT scan of the abdomen and pelvis revealed that the 6 cm-long aortic aneurysm extended into the right common iliac artery, involving this artery throughout its length. The normal aorta between the aneurysm and renal arteries was 18 mm long and 24 mm in diameter; this would provide an adequate proximal neck to accommodate stent-graft repair. The left common iliac artery was deemed suitable for attaching the distal end of one limb of the bifurcated stent-graft, but the right common iliac aneurysm made this an unsuitable site for landing the other limb. The right external iliac artery, however, appeared to be an appropriate landing site.

The findings of the CT scan were confirmed by an angiogram, which also allowed measurement of the length of stent-graft that would be needed to completely exclude the aneurysm.

Before the stent-graft could be placed, however, the right internal iliac artery needed to be occluded to prevent backflow through this vessel and into the aneurysm after the stent-graft was deployed. This was accomplished by placing several metallic coils into the internal iliac artery; the coils caused the vessel to thrombose and become occluded. The coils were placed under X-ray guidance by sliding them through a catheter introduced into the vasculature through a puncture in the groin.