Cystic myxomatous degeneration of the right common and external iliac artery

Abstract

• Please address all correspondence to: W. E. Tuinebreijer, Vondellaan 13, Rode Kruis Ziekenhuis, 1942 LE Beverwijk, The Netherlands, tory of intermittent claudication affecting the right upper and lower leg. Her exercise tolerance, which was initially 100m, became normal with exercise therapy but two months before admission her complaints reappeared suddenly and worsened progressively. The patient had been a smoker until 12 months prior to admission (10-12 cigarettes a day), but otherwise there were no risk factors for atherosclerosis. On examination the pulse in the right groin was found to be diminished and no distal pulses were palpable. In the left leg normal peripheral pulses were palpable. The ankle systolic pressure index at rest was 0.55 in the right leg and 1.03 in the left leg. Arteriography showed a smooth walled stenosis of the right common iliac artery, and complete occlusion of the right external lilac and common femoral arteries (Fig. 1). At operation the right common and external iliac arteries and the common femoral artery were exposed and seen to contain a clear liquid and to be dilated. Through arteriotomies in the common femoral and common iliac arteries mucoid liquid under pressure escaped and the intima was found to be dissected by the fluid. An endarterectomy of the common femoral and iliac arteries was easily performed. At the distal end of the mucoid degeneration the intima was well attached. The arteriotomies were closed by direct suture. The patient remained symptom-free 20 months after the operation, with a normal arteriogram and a normal ankle systolic pressure index.