A Case of Common Iliac Aneurysm Accompanied by Arteriovenous Fistula Treated with Emergency Stent Graft Placement

Abstract

We treated an iliac aneurysm complicated with an arteriovenous fistula by stent-graft surgery with a good outcome. The subject was a 58-year-old man. He visited our hospital with the chief complaint of right leg edema. Physical examination revealed swelling of the right lower leg and tenderness in the right groin region. The ultrasound examination of the lower legs showed arterial pulsatile signals in the right femoral veins that suggested an arteriovenous fistula. Contrast-enhanced computed tomography (CT) examination indicated a 70-mm right common iliac aneurysm. Since the veins in succession to the common iliac vein appeared with marked enhancement on arterial-phase CT, we diagnosed rupture of a right common iliac aneurysm complicated with an arteriovenous fistula. We performed an emergency coil embolization for the internal iliac artery and an emergency stent-graft placement in the right iliac artery. On post-operative day 5, the CT examination showed disappearance of the arteriovenous fistula, but because of the development of thrombosis in the right iliac vein, we started anticoagulant therapy. On day 14 of illness, the patient was discharged. Subsequent CT examinations indicated that the thrombosis in the iliac vein disappeared and that the aneurysm decreased in size.