Endovascular Repair of Iatrogenic Common Iliac Artery Pseudoaneurysm: A Case Report

Purpose: We illustrate a rare case of an iatrogenic common iliac artery pseudoaneurysm presenting as arterio-enteric fistula after percutaneous radiofrequency 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 patients with common iliac artery pseudoaneurysms.

Materials and Methods: A 23-year-old man had 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 a retroperitoneal mass encasing the bilateral iliac arteries. The procedure was uneventful, and there were no immediate postprocedure complications. One week after the procedure, the patient suddenly had massive hemoptysis with severe hypotensive shock. An urgent conventional angiogram was done, which showed a right common iliac artery pseudoaneurysm ruptured into the adjacent bowel. It was decided to sacrifice the right common iliac artery because a 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. Postprocedure angiography 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 computed tomography 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 are 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 present a very rare case of iatrogenic pseudoaneurysm of the right common iliac artery presenting as massive hemoptysis caused by arterio-enteric fistula. The patient was successfully treated using coils and stent graft.