Endovascular repair of a hypogastric artery aneurysm with arteriovenous fistula in a patient with iliac vein thrombosis: A case report

Abstract

Introduction and importance

Abdominal aneurysms, often involving the iliac arteries, pose serious risks if untreated. Iliac arteriovenous fistulas (AVFs) are rare, typically secondary to trauma or deep vein thrombosis, with unclear mechanisms. They may present with high-output heart failure, abdominal bruits, and venous congestion. Computed tomography angiography (CTA) is essential for diagnosing aortoiliac aneurysms and fistulas. Endovascular repair, including recanalization and stenting, is the preferred approach, emphasizing precise preoperative planning and intraoperative execution to restore hemodynamics and minimize complications.

Case presentation

A 65-year-old male with chronic venous insufficiency for 12 years presented with acute left leg pain, severe edema, and inflammation. Despite persistent symptoms, no prior work-up had been performed, and he had only used compression stockings. Doppler sonography revealed acute thrombosis of the left common and external iliac veins with a pelvic vascular mass. He was admitted and started on anticoagulation. CTA identified a 90-mm left internal iliac artery aneurysm, an iliac AVF, and left common iliac vein occlusion. Endovascular repair was planned with initial coil embolization, but due to the aneurysm's size, a stent graft was deployed from the left common iliac to the proximal external iliac artery, successfully excluding the aneurysm. The patient recovered uneventfully with significant symptom relief.

Clinical discussion

The coexistence of an aneurysm and an AVF has not been reported in Iran. Ilio-iliac AVF, a rare complication of aortoiliac aneurysms, requires thorough evaluation.

Conclusion

CT angiography is crucial, especially in atypical cases. Selecting the optimal endovascular approach remains a challenge, requiring individualized management.