Abstract
A 70-year-old male presented in the emergency department of our hospital complaining of left flank pain of acute onset. The patient was a hypertensive, heavy smoker and his medical history revealed no previous episode of renal colic pain. Palpable pulses were detected along the entire length of both lower limbs. Since the patient was hemodynamically stable and the laboratory assessment was normal, the patient was admitted to the orthopedic department. However, since the pain did not subside, magnetic resonance imaging with contrast was conducted, revealing a 6-cm wide pseudoaneurysm attributed to a ruptured atherosclerotic plaque or penetrating atherosclerotic ulcer of the left common iliac artery (Panel A, posterior view).
Accordingly, the patient was immediately transferred to the angiographic suite, where the aforementioned finding was confirmed (Panel B-1). Successful endovascular treatment was performed with insertion of two balloon-expandable stent-grafts (6×59 mm Advanta V12; Atrium Medical Corporation, Hudson, NH, USA) through percutaneous bilateral femoral access. Deployment was conducted in a ‘kissing’ fashion in order to effectively seal the rupture site on the left without compromising the right iliac ostium. Completion angiography (Panel B-2) confirmed the total exclusion of the rupture site. The patient was discharged on the second postoperative day.
Non-aneurysmatic, non-traumatic, spontaneous thoraco-abdominal aortic rupture comprises a rare vascular emergency, attributed to localized medial disruption from a penetrating ulcer in the elastic lamina of the wall, localized dissection or intramural hematoma. However, isolated non-aneurysmatic rupture of the iliac arteries has only rarely been reported in the literature; thus, its diagnosis is often delayed due to under-recognition. An endovascular approach comprises a safe and efficient modality for treating this entity.
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Footnotes
Declaration of conflicting interest
The authors declare that there is no conflict of interest.
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.