82 - Endovascular Repair of Iatrogenic Common Iliac Artery Pseudoaneurysm: A Case Report
Purpose: We aim to illustrate a rare case of an iatrogenic common iliac artery pseudoaneurysm presenting as arterioenteric fistula after percutaneous radoifrequency ablation of retroperitoneal sarcoma that underwent successful treatment with coil embolization with aorto uni-iliac stent-graft placement. We will discuss the prevalence, risk factors, and pathogenesis of common iliac artery pseudoaneurysm. We will also review the current state-of-the-art treatment for common iliac artery pseudoaneurysms
Material and Methods: A 23 male patient was a known case of unresectable retroperitoneal sarcoma encasing and compressing the bilateral common iliac arteries. The patient had grade III claudication and was referred to the Department of Interventional radiology for percutaneous ablation of retroperitoneal mass. The patient underwent percutaneous radiofrequency ablation of retroperitoneal mass encasing the bilateral iliac arteries. The procedure was uneventful and there were no immediate post-procedure complications. After a week of the procedure patient suddenly has massive hemoptysis with severe hypotensive shock. An urgent conventional angiogram was done which showed right common iliac artery pseudoaneurysm ruptured into the adjacent bowel. It was decided to sacrifice the right common iliac artery as guidewire could not be negotiated across the aneurysm. The aneurysm was embolized using vascular plugs and multiple interlocking coils. A covered auto uni-iliac stent-graft was placed on the left side. Post-procedure angiogram showed complete cessation of blood flow across the aneurysm. The flow in the right lower limb was through the collaterals from the left internal iliac artery and right lumbar arteries. The patient had an uneventful recovery and was discharged in stable condition. Follow up CT scan showed a patent stent graft.
Results: Isolated true and false iliac artery aneurysms are rare. Cases of iliac artery pseudoaneurysms presenting as arterio-enteric fistula are even less common and very rarely reported in the literature. It is important to recognize them promptly because they have a very high mortality rate. The most common cause of acquired common iliac artery pseudoaneurysm is trauma. Other less common causes are malignancy and iatrogenic.
Conclusions: We presented as a very rare case of iatrogenic pseudoaneurysm of the right common iliac artery presenting as massive hemoptysis due to arterio-enteric fistula. It was successfully treated using coils and stent graft.