Abstract
BackgroundA solitary iliac aneurysm (SIA) is more uncommon than an abdominal aortic aneurysm. The aneurysm is located in the deep pelvis and is diagnosed when it reaches a large size with symptoms of compression around adjacent structures and organs or when it ruptures. A definite diagnosis of an arteriovenous fistula (AVF) associated with a SIA is difficult preoperatively because there might not be enough symptoms and time for diagnosis. Here, we present a patient with asymptomatic rupture of SIA into the common iliac vein with characteristic blood pressure shifts.Case presentationA 41-year-old man with a huge SIA underwent aortobifemoral graft replacement. Preoperatively, his blood pressure showed characteristic shifts for one or two heartbeats out of five beats, indicating that an AVF was present and that the shunt was about to having a high flow. During surgery, an AVF associated with the SIA was found to be concealed owing to compression from the huge iliac artery aneurysm, and the shunt showed a high flow, resulting in shock during the surgery. No complications were noted after aortobifemoral graft replacement. Postoperatively, we noted an enhanced paravertebral vein on computed tomography (CT), which indicated the presence of an AVF.ConclusionsDefinite diagnosis of an AVF offers advantages in surgical and anesthetic management. We emphasize that a large SIA can push the iliac vein and occlude an AVF laceration, concealing the enhancement of the veins in the arterial phase on CT. Blood pressure shifts might predict the existence of a concealed AVF that has a large shunt. Even if the vena cava and the iliac veins are not enhanced on CT, anesthesiologists should carefully determine whether their distal branches are enhanced.
Highlights
A solitary iliac aneurysm (SIA) is more uncommon than an abdominal aortic aneurysm
We emphasize that a large SIA can push the iliac vein and occlude an arteriovenous fistula (AVF) laceration, concealing the enhancement of the veins in the arterial phase on computed tomography (CT)
Even if the vena cava and the iliac veins are not enhanced on CT, anesthesiologists should carefully determine whether their distal branches are enhanced
Summary
We report a patient with asymptomatic rupture of a SIA into the common iliac vein with characteristic blood pressure shifts. It was believed that the AVF did not cause a shock preoperatively because the laceration was small, the aneurysm ruptured into a relatively minor vein, and the huge aneurysm decreased shunt flow owing to compression of the common iliac vein. Surgical repair of arteriovenous fistula associated with iinfrarenal aorto-iliac aneurysm: report of two contrasting cases. Successful surgical repair of an ilio-iliac arteriovenous fistula associated with a ruptured common iliac artery aneurysm. Authors’ contributions SD participated in the study design, data collection, data analysis, and manuscript preparation. All authors read and approved the final manuscript. Author details 1Department of Anesthesiology, Sanai Hospital, 4-35-17 Tajima, Sakura-ku, Saitama City, Saitama 338-0837, Japan. Author details 1Department of Anesthesiology, Sanai Hospital, 4-35-17 Tajima, Sakura-ku, Saitama City, Saitama 338-0837, Japan. 2Department of Anesthesiology, Tobu Chiiki Hospital, Tokyo, Japan
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