We report a case of aorto-iliac occlusion due to
descending aortic dissection treated initially with femoro-femoral
cross-over bypass and secondarily with unilateral aorto-iliac stenting
because of progression of the dissection. A 75-year-old man presented
with acute ischemia of the right leg. CT revealed occlusion of the
right iliac artery due to descending aortic dissection with a clotted
false lumen. Three days after femoro-femoral cross-over bypass,
ischemia of both legs developed and angiography demonstrated occlusion
of the infrarenal aorta and left common iliac artery. Two overlapping
stents were deployed in these vessel segments. Completion angiography
confirmed successful recanalization with adequate distal flow and good
patency of the cross-over bypass. Peripheral pulses were restored and
the patient’s symptoms were alleviated. Combined treatment with
cross-over bypass and endovascular recanalization may be considered as
a viable alternative to open aortic surgery in selected cases of
complicated aorto-iliac dissection with bilateral leg ischemia.