60 year old female, smoker, underwent aorto-bifemoral bypass graft placement for severe iliac artery occlusive disease and short distance claudication. Patient had symptomatic improvement but quickly deteriorated on the right with worse symptoms than prior to surgery. Exercise ABI's showed severe PAD with claudication at 125 yards. Patient was at risk of losing employment - patient works in a Walmart warehouse and could not walk quickly or far enough. Patient did not want another open procedure. Endovascular repair was accomplished in 60 minutes using atherectomy and angioplasty. Patient returned to work the next day symptom free. In addition, the patients rest pain and night resolved.
Nutcracker syndrome is one of the causes of secondary pelvic congestion syndrome.
Severe aortoiliac occlusion with rest pain and short distance claudication treated with novel CERAB technique using covered stent grafts.