Bilateral Leg Edema Research Articles

A case of polyarteritis nodosa associated with cytomegalovirus infection.

A 77-year-old man suffering from prolonged fever of unknown origin and bilateral leg edema was referred to our hospital. On physical examination, he had fever, general fatigue, bilateral lower leg edema, and muscle weakness of the right upper extremity and left lower extremity. Neurological examination indicated motor and sensory disturbance. Electromyography revealed mononeuritis multiplex and myopathy. A biopsy of the left biceps muscle indicated necrotizing vasculitis with fibrinoid necrosis. Considering all the data together, he was diagnosed as having polyarteritis nodosa (PAN) and concurrent active cytomegalovirus (CMV) infection. His symptoms improved promptly on treatment with 50 mg of prednisolone. This case emphasizes the importance of CMV infection as one of possible etiologies of PAN and reports a therapeutic strategy for this syndrome.

Chylothorax in POEMS Syndrome

Chylothorax results from various causes, such as malignancy, trauma, or infection. POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) is a multisystemic syndrome that is associated with plasma cell disorder. Pleural effusion is a common manifestation of POEMS syndrome, but the association of POEMS syndrome with chylothorax has not been reported. We report on a 61-year-old female patient who initially presented with dyspnea and bilateral leg edema. Importantly, the patient had normal renal function. Her chest X-ray and computed tomographic imaging showed bilateral pleural effusion, and her chest drainage revealed chylothorax. Detailed examination failed to reveal the definitive cause of the chylothorax. She received several treatments for chylothorax, namely, a low-fat diet or fasting, total parenteral nutrition, a somatostatin analog (octreotide), thoracic duct ligation by video-assisted thoracic surgery, and pleurodesis. However, further examination revealed endocrinopathy, monoclonal plasma cell disorder, peripheral neuropathy, and elevation of the serum level of vascular endothelial growth factor. The patient's condition was consequently diagnosed as POEMS syndrome. Eventually, her chylothorax was controlled by pleurodesis, and she was transferred to another hospital for stem cell transplantation. Herein, we report on the apparent first case of POEMS syndrome with chylothorax. In some cases of idiopathic chylothorax, the underlying primary disease may be latent, such as in the present patient. POEMS syndrome is rare, but this syndrome should be included in the differential diagnosis of chylothorax with unexplained etiology.

Acute bilateral leg edema due to levofloxacin.

Acute bilateral leg edema due to levofloxacin.

Characterization of the Syndrome of Acute Liver Failure Caused by Metastases from Breast Carcinoma

To characterize syndrome of acute liver failure (ALF) from metastatic breast cancer to promote premortem diagnosis. Up to now, only 25 % of the reported 32 cases of this syndrome were diagnosed premortem. Cases identified by computerized literature review and review of files maintained by senior investigator. Among 32 cases, average age at presentation was 47.9 ± 9.9 years. Common signs include jaundice, hepatomegaly, shifting dullness, and bilateral leg edema. Mean serum level of AST was 296.4 ± 204.0 U/L, ALT, 183.2 ± 198.9 U/L; alkaline phosphatase, 641.5 ± 610.1; and total bilirubin, 8.6 ± 8.3 mg/dL. Twenty-seven patients (84 %) have known prior breast cancer (mean diagnosis = 4.1 + 4.8 years earlier). Abdominal ultrasound findings (N = 10) include hepatomegaly in three cases, heterogeneous/multifocal hepatic lesions in three, ascites in three, and other in two. Abdominal CT findings (N = 16) include heterogeneous/multifocal hepatic lesions in six cases, ascites in five, hepatomegaly in three, cirrhosis in three, fatty liver in two, other in two. Hepatic metastases may not be suspected when abdominal CT shows no hepatic lesions. The diagnosis is made postmortem in 24 cases and antemortem in eight, with a statistically significant trend of increasing premortem diagnosis since 2000 (0 % before 2000 vs. 50 % after 2000; p = .001, 95 %--ORCI ≥ 2.86, Fisher's exact test). A new case of ALF from breast cancer is reported with notable features: abdominal CT revealed no discrete hepatic lesions despite widespread hepatic metastases demonstrated by liver biopsy; hepatic metastases occurred 21 years after original breast primary; and original diagnosis of lobular breast cancer in primary lesion was corrected to mixed ductal and lobular carcinoma, based on immunohistochemistry, performed 21 years afterward. This review characterizes the clinical presentation and natural history of this syndrome to promote liver biopsy for premortem diagnosis and appropriate therapy.

Bilateral leg edema in an older woman

Bilateral leg edema is a frequent symptom in older people and an important concern in geriatric medicine. Further evaluation is frequently not performed and simple therapy with diuretics is prescribed. Particularly in older patients, long-term use of diuretics can lead to severe electrolyte imbalances, volume depletion, and falls. In this case report we want to focus the physicians' attention on the necessity to determine the cause and show a correspondingly effective treatment for bilateral leg edema in older people. A thorough approach is required to recognize diseases and to avoid adverse drug events as geriatric patients often show an atypical presentation or minor symptoms. The cause of swollen legs is often multifactorial; therefore, the patient's individual history and an appropriate physical examination are important. Depending on the clinical symptoms, evaluation including basic laboratory tests, urinalysis, chest radiography, and echocardiogram may be indicated. The most probable cause of bilateral edema in older patients is chronic venous insufficiency. Heart failure is also a common cause. Other systemic causes such as renal disease or liver disease are much rarer. Antihypertensive and anti-inflammatory drugs can frequently cause leg edema, but the incidence of drug-induced leg swelling is unknown. With the help of this special case we tried to develop an approach to the diagnosis of symmetric leg edema in older patients, a problem frequently neglected in geriatric medicine.

Left Ventricular Assist Device Implantation Induced Tricuspid Valve Prolapse

A 46-year-old nonsmoking male patient without significant medical history was referred to our intensive care unit for cardiogenic shock. Progressive dyspnea developed during the past 2 weeks. Heart rate was at 120 beats per minute and blood pressure at 80/60 mm Hg at admission. Physical examination revealed cool extremities with bilateral leg edema, jugular venous distension, systolic murmur, and S3 gallop. ECG showed sinus tachycardia without ST segment abnormality. Chest radiograph showed cardiomegaly and bilateral alveolar infiltrates. Bedside echocardiography revealed a dilated left ventricle (LV) at 80 mm and a poor LV function (LV ejection fraction measured at 10% and forward stroke volume at 27 mL) without valvular disease. Right ventricular (RV) function was normal (tricuspid annular plane systolic excursion at 22 mm and peak tricuspid tissue Doppler S wave at 12 mm/s). Renal and liver dysfunctions were found on laboratory data. Coronary angiography was normal. Cardiac MRI showed a dilated cardiomyopathy without perfusion abnormality or late gadolinium enhancement and a normal RV. The use of loop diuretic and inotropic support produced significant improvement in symptoms, hemodynamic status, and end-organ function. Because …

P2–072 - Case of Prolonged Bradycardia Induced by Bevacizumab-Associated Infusion Reaction in Advanced Metastatic Colon Cancer

A 71-year-old man complaining of bilateral leg edema and general fatigue was admitted to the hospital and diagnosed as advanced sigmoid colon cancer with multiple liver and lung metastasis. 5-FU/Leucovorin/Oxaliplatin(FOLFOX)/Bevacizumab was started as a first-line therapy. In the second course of FOLFOX/Bevacizumab, just after finishing infusion of bevacizumab, he felt severe thrill with chill and got fever (maximum of 38.1 degree Celsius). Since the symptom was diagnosed as an infusion reaction induced by Bevacizumab, treatment with steroid and histamine antagonist was performed.

Bilateral leg edema in older patients

function and cognitive function on muscle strength. We evaluated the relationship between grip strength and severity of PD adjusting for major determinants of muscle strength. Methods.– Age, height, weight, maximum grip strength, Unified Parkinson’s Disease Rating Scale (UPDRS) motor score, Hoehn and Yahr (H & Y) stage, number of co-morbidities and medications, Barthel score, Mini Mental State Examination (MMSE), Malnutrition Universal Screening Tool (MUST) and number of falls in the last year were assessed with participants in the “on” state. Results.– Thirty-four men and 23 women with PD, mean age 71.3 (standard deviation (SD) 8.0) and 72.6 years (SD 7.6), living in one town in England were recruited. Each unit increase in UPDRS score (–0.3 kg (95% confidence interval (C.I.)–0.51, –0.09): P=0.006) and H & Y stage (–3.87kg (95%C.I.–6.54, –1.21): P=0.005) was significantly associated with lower grip strength in univariate linear regression analyses adjusted for gender. In a multivariate regression model the severity of PD (as indicated by UPDRS score or H&Y stage) was the most important determinant of grip strength after age, gender and height. Key conclusions.– Increased severity of Parkinson’s disease is significantly associatedwithmuscleweakness. This appears to be distinct from the effects of reduced physical function or poor cognition and the mechanism is unclear.

Changing Pattern of Epidemic Dropsy in North India

Background:Epidemic dropsy occurs due to ingestion of mustard oil contaminated with oil from Argemone mexicana, leading to edema and tenderness of the abdomen, upper and lower limbs. In this study, clinical profiles of patients presented with epidemic dropsy in north India are described. Methods: This was a prospective study of patients presented with epidemic dropsy to the emergency department of Nehru Hospital, during the period from March 2004 to December 2011. Inclusion criteria were patients presenting with tender bilateral pitting leg edema and dermal telangiectasia. Clinical and laboratory data of patients were entered into case record forms at the time of presentation until discharge from the hospital. Results: Leg edema was the principal symptom in our series, and was in concurrence with current literature. Erythema has only been reported in 35-82% of published series, though it was present in all of our patients. Similarly, features such as diarrhea, hepatomegaly and anemia were more frequent in our cases compared to the literature. Furthermore, pancytopenia which was documented on peripheral blood counts in 54% of our cases has never been reported before. Conclusion: Epidemic dropsy should be considered in patients presenting with progressive erythema, edema, and tenderness of the limbs who had a history of consumption of mustard oil and confirmation of Argemone oil contamination according to laboratory tests.

Clinical Characteristics of Lower‐Extremity Edema in Stage A Cardiovascular Disease Status Defined by the ACC/AHA 2001 Chronic Heart Failure Guidelines

Checking for lower-extremity edema is important for diagnosing, monitoring, and managing heart failure (HF). However, the characteristics of this sign in the early stages of cardiovascular disease (stage A, as defined by the American College of Cardiology/American Heart Association 2001 chronic HF guidelines) have not been adequately explored. We hypothesized that stage A HF patients (at risk for HF) are free from leg edema. After the exclusion of patients with high serum creatinine levels (≥1.2 mg/dL), abnormal electrocardiogram rhythm, and/or comorbid critical disease(s), we studied the prevalence and predictors for leg edema in 274 subjects at risk for heart failure but without structural heart disease or symptoms of HF. The overall prevalence of lower-extremity edema was 33 of 274 patients (12.0%; 95% confidence interval: 8.2%-15.9%). In most patients (29/33, 88%), the leg edema involved only the ankle and foot. Compared with patients without leg edema (n = 241), those with leg edema (n = 33) were older (age, 74 ± 11 7 vs 69 ± 12 years, P = 0.006), more likely to present with pulmonary crackles (52% vs 31%, P < 0.03), and more likely to have varicose veins (55% vs 15%, P < 0.001). Leg edema and varicose veins coexisted in 19 (58%) patients, of whom 16 patients were women. On multivariate analysis, the presence of varicose veins was the only independent predictor of the appearance of bilateral leg edema (odds ratio: 8.18, 95% confidence interval: 3.92-17.1, P < 0.001). A mild degree of leg edema is not uncommon in patients at risk for HF. Recognition of this phenomenon might be important for evaluation, monitoring, and self-care of HF patients.

PM.68 Management Dilemmas of Conn’s Syndrome in Pregnancy

The most common cause of primary hyperaldosteronism is Conn’s syndrome (80%), and treatment resistant hypertension with hypokalaemia in pregnancy should prompt investigation for this. There is physiological up-regulation of the...

A patient with esophageal cancer showing remission of nephrotic syndrome after esophagectomy: report of a case

A 73-year-old male patient was admitted to our hospital due to bilateral leg edema and proteinuria in April 2009. After admission, nephrotic syndrome (membranous nephropathy) was diagnosed. At that point, a cancer screening test was performed; however, no abnormalities were noted. Medical treatment with prednisolone and cyclosporine was started, which resulted in the temporary improvement of markers of laboratory data. The patient was re-examined in November of the same year, and esophageal cancer (squamous cell carcinoma, T2N0M0 Stage IIA according to the UICC TNM classification) was detected in the lower thoracic esophagus. Subtotal esophagectomy was performed via right thoracolaparotomy with two-field lymph node dissection. Although the patient's course was complicated by respiratory failure, he was discharged after 38 days. After performing esophagectomy, prompt amelioration of the nephrotic syndrome occurred, allowing the withdrawal of prednisolone and cyclosporine. There has been no recurrence of esophageal cancer or relapse of nephrotic syndrome during a period of 18 months after esophagectomy.

High-Output Heart Failure Resulting From Chronic Aortocaval Fistula

A 61-year-old man was admitted to the hospital complaining of bilateral leg edema and dyspnea lasting for 1 month and resistant to diuretic therapy. His past medical history included hypertension, smoking, pneumonia, and chronic alcoholism. There was no history of abdominal trauma. The heart rate was 110 beats per minute (bpm), and blood pressure was normal (135/75 mm Hg). Physical examination also revealed clinical signs of right heart failure, including peripheral edema, hepatomegaly, jugular vein dilatation, ascites, and right pleural effusion. There were no signs of portal hypertension or hepato-cellular insufficiency. There was no pulsatile mass nor abdominal murmur. The liver tests revealed moderate cytolysis and cholestasis and an elevated brain natriuretic peptide value of 1322 pg/mL (normal value <500 pg/mL). Complete blood count, hemostasis, renal function, and …

Stasis Dermatitis as a Complication of Recurrent Levofloxacin-Associated Bilateral Leg Edema

Several drugs have been associated with the development of peripheral edema. Leg edema can result in dermatitis of the lower extremities. We describe levofloxacin-induced peripheral leg edema, which progressed to stasis dermatitis. A 76-year-old man with a history of esophageal adenocarcinoma was administered intravenous vancomycin and a combination of piperacillin and tazobactam by injection for treatment of aspiration pneumonia. Prior to discharge, the patient's antibiotic therapy was switched to oral levofloxacin. The patient developed drug-associated bilateral peripheral leg edema and stasis dermatitis. Both the dermatitis and leg edema resolved after withdrawal of levofloxacin and administration of topical corticosteroid therapy. The patient had a similar reaction to levofloxacin one year prior, which had subsided with discontinuation of the drug. Several medications have been documented to cause leg edema and secondary stasis dermatitis. The timing, recurrence, and resolution of edema and stasis dermatitis with respect to the administration and termination of levofloxacin suggest that the leg edema and stasis dermatitis occurred secondary to levofloxacin administration. Levofloxacin can be added to the list of drugs associated with the development of peripheral leg edema. Stasis dermatitis proceeded by lower extremity edema can be added to the list of adverse events associated with levofloxacin.

Giant Left Atrial Myxoma in a Nonagenarian

An independent 90-year-old man presented with progressive shortness of breath. A left atrial mass had been accidentally found on chest computed tomography at another hospital 2 years earlier. He had declined further investigation and treatment for the mass. He had been asymptomatic until 3 months earlier. He had undergone a unilateral nephrectomy for renal cell carcinoma 17 years before and had been free of recurrence after surgery. His family history was unremarkable. On physical examination, his pulse rate was 63 beats per minute, and blood pressure was 132/62 mmHg. He had bilateral leg edema and a distended jugular vein. An accentuated first heart sound without tumor plop or diastolic murmur was heard. Breath sounds were diminished. Electrocardiogram was unremarkable. Chest X-ray showed bilateral pleural effusion. Transthoracic and transesophageal echocardiography revealed a mobile and pedunculated mass in the left atrium attached to the interatrial septum (Figure 1A). The mass prolapsed into the left ventricle across the mitral valve, resulting in mitral valve obstruction and pulmonary hypertension. Tricuspid regurgitation was mild, with a pressure gradient of 53 mmHg. The inferior vena cava was 18 mm in diameter, with low respiratory change. The mitral valve appeared structurally normal, and mitral regurgitation was trivial. The left ventricle was normal in size and function. He was open to the prospect of surgical removal of the mass and accepted after obtaining the details of the surgery and discussing matters with us and his family. He underwent surgical resection of the mass (Figure 1B). Histologic examination confirmed a diagnosis of myxoma. Postoperatively, pressure gradient calculated from tricuspid regurgitation decreased to 27 mmHg. He recovered without major complication and was discharged. Left atrial myxoma is histologically benign and is the most common primary tumor of the heart.1 It is particularly frequent between the third and sixth decades of life. Atrial myxoma in older people is considered to be unusual, but with the advent of newer imaging modalities and longer life expectancy, the incidence of myxoma in older people has increased.2, 3 In a series of 100 individuals with atrial myxoma, 19% were aged 70 and older.2 A recent review also reported 63 individuals with cardiac myxoma aged 68 to 88.3 Cardiac myxomas in older people were surgically resected with mortality of 1.7%.3 Most of their presenting symptoms resolved after surgical removal. To the best of the authors’ knowledge, the current patient is the oldest person with atrial myxoma who has undergone surgical resection.3, 4 Atrial myxoma is among the great mimickers of clinical medicine.5 It should be put on a list of differential diagnoses for heart failure even in older people. Surgical resection could lead to resolution of symptoms and avoidance of devastating complications. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: YM: Imaging, management of the patient, writing the report. MW, KH: Imaging. YN, YB, TK, NY: Management of the patient. TF, HK, KO, YD: Management of the patient, reviewing the text. TS: Imaging, reviewing the text. Sponsor's Role: None.

Severe Hypokalemic Paralysis as a Manifestation of a Mitochondrial Disorder

Mitochondrial disorder (MtD) is usually a multisystem disease due to impaired mitochondrial energy production. Severe hypokalemia resulting in muscle weakness and rhabdomyolysis has not been reported as a phenotypic feature of MtD. Here we describe a 60-year-old male patient who developed myalgias followed by generalized muscle weakness a few days before admission. Symptoms were attributed to severe hypokalemia that occurred after the patient had discontinued spironolactone, a competitive antagonist of the aldosterone receptor, four months earlier on his own judgment. Spironolactone was given for 10 years to treat suspected primary hyperaldosteronism (Conn's syndrome). He presented with myopathic face, bilateral ptosis, hypertelorism, brachydactylia, weakness of the axial and limb muscles, and bilateral leg edema. Hypertelorism and brachydactylia are known as physical traits of MtD. Laboratory investigations revealed hypokalemia of 1.7 mmol/l and elevated serum levels of creatine kinase (2,772 U/l). Electrocardiogram showed sinus rhythm, left bundle-branch-block, repolarization abnormalities, and prolonged QTc (571 ms), which is associated with a propensity to ventricular arrhythmias. Diagnostic work-up revealed bilateral adenomas of the suprarenal glands. Conn's syndrome was regarded as a manifestation of MtD, since MtDs are frequently associated with endocrine abnormalities. The patient also presented with occasional double vision, ptosis, renal insufficiency, bilateral renal cysts, hypertriglyceridemia, arterial hypertension, and hypertrophic cardiomyopathy. Taken together, we have made the diagnosis of MtD. In conclusion, MtD may be associated with adrenal adenomas, which may cause severe symptomatic hypokalemia, manifesting as generalized weakness and myalgias due to rhabdomyolysis. Endocrine involvement may be a phenotypic feature of MtD.

Retroperitoneal malignant nerve sheath tumor

A 72-year-old white female presented with 3-week history of increasing abdominal pain, bilateral leg swelling, decreasing urine output and shortness of breath. She started to have worsening bilateral leg edema right greater than left. She had Doppler ultrasound of her legs which was negative for deep vein thrombosis. She was prescribed furosemide two times daily with minimal improvement in swelling. A few weeks later, she started to have abdominal pain and shortness of breath. Abdominal pain was new onset, dull, right-sided with no radiation or aggravating relieving factors. She noticed abdominal mass incidentally while taking shower which became more apparent on bending. Her past medical history was significant for hypertension, coronary artery disease with bare-metal stent to the right middle coronary artery 9 years ago and insulin-dependent diabetes mellitus. On arrival, her vitals were 36.4°C, 100/68 mm Hg, 97 per min, 31 per min respiratory rate and body mass index 46 kg/m2. Abdominal examination was notable for a right-sided antero-lateral mass with irregular borders …

Characterization of Cardiac Sarcoma With 2- and 3-Dimensional Echocardiography, Myocardial Contrast Echocardiography and Cardiac Magnetic Resonance Imaging

A 57-year–old woman had previously undergone a right hemicolectomy for Duke B adenocarcinoma of caecum. She presented with acute back pain. A magnetic resonance imaging scan of her thoracic spine showed destruction of a vertebra with a tumor deposit at T11 (Figure 1A). She underwent a course of radiotherapy (20 Gray in 5 fractions) to this area. Good symptomatic relief was obtained. Biopsy demonstrated a sarcomatoid tumor suggestive of leiomyosarcoma. Over the next 2 months she developed dyspnea on exertion, fatigue, and leg edema. Examination revealed a regular tachycardia, raised jugular venous pressure, and bilateral leg edema. On auscultation, an added early diastolic sound (consistent with tumor plop) was audible. A 3-dimensional echocardiogram identified a large mass protruding from the right atrium into the right ventricle (Figure 1B and online-only Data Supplement Movie I). The mass prolapsed through the tricuspid valve into the right ventricle during diastole, intermittently obstructing right ventricular inflow and almost completely occluding the tricuspid valve …

True identity of endocapillary proliferation: a case of intravascular large B cell lymphoma diagnosed with immunohistochemical study of kidney biopsy and literature review.

A 78-year-old Japanese female presented with low-grade fever, malaise, and appetite loss lasting for 1month. Upper and lower gastrointestinal endoscopy and contrast-enhanced whole-body computed tomography (CT) revealed no abnormal findings at a referring hospital. She was referred to our hospital because of bilateral leg edema and 2.5g/day proteinuria. Serum creatinine was 0.73mg/dl and the kidneys were not enlarged. Kidney biopsy showed marked endocapillary proliferation with mesangiolysis. Soon after the kidney biopsy, her symptoms improved spontaneously, along with decreases in lactate dehydrogenase (LDH) from 503 to 197IU/l, C-reactive protein (CRP) from 4.47 to 0.66mg/dl, and soluble interleukin-2 receptor (sIL-2R) from 1789 to 1001U/ml. Thus, she was followed carefully as an outpatient. One month later, however, she presented with dysarthria and right-sided hemiparesis, and diffusion-weighted brain magnetic resonance imaging (MRI) showed multiple high-intensity areas. She also had respiratory failure, and lung perfusion scintigraphy showed multiple low blood stream areas. Suspecting some endovascular abnormality, we performed immunohistochemical staining of the kidney biopsy specimen taken previously to find that endocapillary infiltrating cells were CD20-positive B lymphocytes. The infiltrating cells were confined to the endocapillary compartment in glomeruli and peritubular capillaries. Both clinical and pathological findings led us to diagnose intravascular large B cell lymphoma (IVLBCL). Two bone marrow biopsies and random skin biopsies were performed, but no abnormality was found. The present case demonstrates that clinical course and renal biopsy findings of intravascular large B cell lymphoma may mimic other renal conditions and that the identification of cell types with immunohistochemical staining may help establish an accurate diagnosis.

Large arteriovenous fistula between the common iliac artery and the vein after blunt trauma

A 62-year-old man presented to the emergency department with dyspnea on exertion and bilateral leg edema 4 days after falling down stairs and sustaining injuries. The physical examination showed mild respiratory distress and blood pressure of 130/80 mm Hg. Lung examination revealed bilateral basilar rales. A chest radiograph showed mild pulmonary congestion and pleural effusion but no cardiomegaly (A). An axial computed tomography scan (B) showed fracture and spondylosis of the lower lumbar spine and sacrum (*) and a 50-mm thrombosed pseudoaneurysm of the right common iliac artery (CIA) that communicated with the right common iliac vein (CIV) near the distal inferior vena cava (C and D). Transthoracic echocardiography revealed normal mitral, aortic and tricuspid valves, mild dilatation of all cardiac chambers, and normal contraction of the ventricles. There was moderate pulmonary hypertension (right ventricular systolic pressure, 60 mm Hg). The patient’s arteriovenous fistula (AVF) was surgically repaired through a median laparotomy. After proximal and distal control of the aorta and the inferior vena cava was obtained, the pseudoaneurysm was excised, and the AVF defect was repaired with interrupted polypropylene sutures. The size of the AVF was 40 10 mm. After a proximal anastomosis at the distal abdominal aorta and obliteration of both common iliac arteries, distal anastomoses were constructed to the external iliac arteries with a Dacron graft. The patient had an uneventful recovery and was discharged 10 days after surgery. Postoperative computed tomography showed successful excision of the pseudoaneurysm and repair of the AVF.