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Sarafi M, Hatami D, Ansari K, Rast M. Ruptured external iliac artery aneurysm: A case report. Int J Surg Case Rep 2024; 121:109964. [PMID: 38941729 PMCID: PMC11260589 DOI: 10.1016/j.ijscr.2024.109964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/22/2024] [Accepted: 06/25/2024] [Indexed: 06/30/2024] Open
Abstract
INTRODUCTION Iliac artery aneurysms are rare, with isolated iliac artery aneurysms responsible for only 2 % of all aneurysmal diseases. External iliac artery (EIA) aneurysms are extremely rare, and the exact cause is unknown. In this case, we report a giant aneurysm without any risk factor presented with rupture and managed by open repair. PRESENTATION OF CASE An 85-year-old man presented to the emergency department with sudden onset right lower quadrant abdominal pain and vague right lower limb pain. After a complete physical examination, an abdominopelvic CT scan revealed an 80 mm EIA aneurysm containing thrombosis and active leakage. The patient underwent open repair of an aneurysm using a graft between the Aorta and EIA. The surgery was uneventful. Later in the ICU, the patient experienced a cardiac arrest and unfortunately could not recover from it. DISCUSSION In this case, a patient with a relatively large aneurysm presented with abdominal pain and lower limb discomfort. Although endovascular surgery is recommended for the repair of iliac aneurysms, open repair is common for ruptured aneurysms. Endovascular repair is less invasive but may lead to contrast-induced renal dysfunction. Open repair may induce complications such as sexual dysfunctions, graft infection, and pelvic ischemic conditions. CONCLUSION EIA aneurysms are exceedingly rare. They may present with a Rupture that puts the patient in critical condition, such as in this case. Due to the hemodynamic instability, open repair is considered one of the main approaches for repairing the aneurysm.
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Affiliation(s)
- Milad Sarafi
- Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, P.O Box: 14665-354, Tehran, Iran
| | - Donya Hatami
- Research Committee, School of Medicine, Iran University of Medical Sciences, P.O Box: 14665-354, Tehran, Iran
| | - Kiarash Ansari
- Research Committee, School of Medicine, Iran University of Medical Sciences, P.O Box: 14665-354, Tehran, Iran
| | - Moein Rast
- Research Committee, School of Medicine, Iran University of Medical Sciences, P.O Box: 14665-354, Tehran, Iran.
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Moldovan H, Tiganasu R, Câlmâc L, Voica C, Broască M, Diaconu C, Ichim V, Cacoveanu M, Mirea L, Nica C, Minoiu C, Dobra I, Gheorghiță D, Dorobanțu L, Molnar A, Iliuță L. Same Clinical Reality of Spontaneous Rupture of the Common Iliac Artery with Pseudoaneurysm Formation-Comparison of Two Therapeutical Solutions, Endovascular Stent-Graft and Open Surgical Correction, for Two Cases and Review of the Literature. J Clin Med 2023; 12:jcm12020713. [PMID: 36675646 PMCID: PMC9865574 DOI: 10.3390/jcm12020713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/28/2022] [Accepted: 01/06/2023] [Indexed: 01/19/2023] Open
Abstract
The incidence of isolated iliac artery aneurysms is approximately 2% and common iliac artery pseudoaneurysms are even rarer. A pseudoaneurysm is a localized hemorrhage as opposed to an actual aneurysm, which affects the entire vascular wall. They are typically asymptomatic and only detectable accidentally while looking for other causes. If large and symptomatic, they typically exhibit pressure symptoms as a result of the compression of the structures around them. Common symptoms include generalized stomach pain, urological problems, gastrointestinal bleeding, and neurological symptoms such as leg paralysis or sciatica-like back pain. Rarely, they may exhibit hemodynamic instability together with an aneurysm rupture, which has a high fatality rate. Due to the unique presentation, the diagnosis is typically rarely made and there is little experience with treating it. We report two cases of common iliac artery pseudoaneurysm found in two patients who had no notable medical history and who we chose to repair through the endovascular technique in the first case, an approach that has gained more ground for vascular repair worldwide, making it the current go-to method, and for the second case we chose a more traditional approach, through open surgery.
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Affiliation(s)
- Horațiu Moldovan
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 014461 Bucharest, Romania
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
- Academy of Romanian Scientists, 54 Spl. Independentei, 050711 Bucharest, Romania
- Correspondence: (H.M.); (D.G.)
| | - Robert Tiganasu
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
| | - Lucian Câlmâc
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
| | - Cristian Voica
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
| | - Marian Broască
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
| | - Camelia Diaconu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 014461 Bucharest, Romania
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
- Academy of Romanian Scientists, 54 Spl. Independentei, 050711 Bucharest, Romania
| | - Vlad Ichim
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 014461 Bucharest, Romania
| | - Mihai Cacoveanu
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
| | - Liliana Mirea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 014461 Bucharest, Romania
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
| | - Claudia Nica
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
| | - Costin Minoiu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 014461 Bucharest, Romania
| | - Irina Dobra
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
| | - Daniela Gheorghiță
- Faculty of Materials Science and Engineering, Politehnica University of Bucharest, 060042 Bucharest, Romania
- Correspondence: (H.M.); (D.G.)
| | - Lucian Dorobanțu
- Faculty of Medicine, Titu Maiorescu University, 040441 Bucharest, Romania
- Department of Cardiovascular Surgery, Monza Metropolitan Hospital, 040204 Bucharest, Romania
| | - Adrian Molnar
- Faculty of Medicine, Iuliu Hateganu University of Medicine and Pharmacy, 400012 Cluj Napoca, Romania
- Department of Cardiovascular Surgery, Heart Institute, 400001 Cluj Napoca, Romania
| | - Luminița Iliuță
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 014461 Bucharest, Romania
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Bigarella MP, Lopes RI, Gentile G, Faustino CB, da Cunha Gamba L, Lima GBB, Melo HAH, Mulatti GC. Bilateral external iliac artery pseudoaneurysms causing urinary obstruction and acute renal failure. CVIR Endovasc 2022; 5:22. [PMID: 35612659 PMCID: PMC9133281 DOI: 10.1186/s42155-022-00302-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/12/2022] [Indexed: 12/03/2022] Open
Abstract
Background We report an exceedingly rare case of bilateral external iliac artery pseudoaneurysms causing urinary obstruction and acute renal failure. Case presentation A young man presented with acute severe bilateral testicular pain radiating to the back. Clinical and radiological workup showed bilateral external iliac artery pseudoaneurysms, which caused bilateral ureterohydronephrosis due to urinary obstruction with subsequent renal failure. Management included immediate bilateral external iliac artery endovascular repair and bilateral ureterolysis using a retroperitoneal approach, with resolution of the obstruction and successful endovascular treatment of both pseudoaneurysms. The only identifiable risk factor for cardiovascular disease was cocaine addiction. Conclusions This case highlights an unusual and severe clinical presentation of bilateral EIA pseudoaneurysms causing bilateral ureterohydronephrosis and subsequent renal failure. Awareness of this condition may help avoid misdiagnosis and delayed management, which is of utmost importance for a favorable outcome.
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Affiliation(s)
- Marcelo Puppo Bigarella
- Division of Urology, Department of Surgery, University of São Paulo School of Medicine, Rua Helena 218 4 floor 410 - Sartor Medicina, São Paulo, 04552-050, Brazil.
| | - Roberto Iglesias Lopes
- Division of Urology, Department of Surgery, University of São Paulo School of Medicine, Rua Helena 218 4 floor 410 - Sartor Medicina, São Paulo, 04552-050, Brazil
| | - Guilherme Gentile
- Division of Urology, Department of Surgery, University of São Paulo School of Medicine, Rua Helena 218 4 floor 410 - Sartor Medicina, São Paulo, 04552-050, Brazil
| | - Carolina Brito Faustino
- Division of Vascular Surgery, Department of Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Lais da Cunha Gamba
- Division of Vascular Surgery, Department of Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Henry Augusto Hoffman Melo
- Division of Vascular Surgery, Department of Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Grace Carvajal Mulatti
- Division of Vascular Surgery, Department of Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
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Tanaka CM, Matielo MF, Nakamura ET, Tiossi SR. Bilateral external iliac artery aneurysm in a young man. J Vasc Surg Cases Innov Tech 2022; 8:57-59. [PMID: 35118216 PMCID: PMC8792393 DOI: 10.1016/j.jvscit.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/09/2021] [Indexed: 11/15/2022] Open
Abstract
Most iliac artery aneurysms occur in association with aortic aneurysms. Isolated aneurysms of the iliac arteries are uncommon, and those of the external iliac arteries are even more rare. In the present report, we have presented the case of a bilateral external iliac artery aneurysm in a young man.
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