Abstract
An 87-year-old woman was admitted to the emergency department due to disturbance of consciousness. Subsequently, the condition was identified as shock. We diagnosed a right common iliac artery aneurysm (CIAA) rupture with contrast-enhanced abdominal computed tomography, which did not show extravasation of the contrast agent but showed a rugged vessel wall; it also revealed bilateral CIAA. Hemorrhagic shock responded to fluid resuscitation. Further, the patient had risk factors for surgery including advanced age, history of an abdominal surgery, hypertension, and dementia. Therefore, our therapeutic strategy for the right CIAA rupture was to perform endovascular aneurysm repair (EVAR) rather than an abdominal surgery because EVAR is less invasive than open surgery. Preoperative planning of EVAR includes occluding bilateral internal iliac arteries followed by placing a stent graft. The patient's hemodynamics stabilized after surgery, and she returned home without any complications. We therefore suggest that patients who have risk factors for abdominal surgery and in whom hemorrhagic shock responds to fluid resuscitation might benefit from EVAR for an iliac artery rupture.
