External Iliac Artery Pseudoaneurysm Research Articles

227 Never reported Complication of open Right hemicolectomy -Right external iliac artery pseudoaneurysm with arterio colonic fistulae presenting as delayed postoperative anastomotic bleeding – a case report and review of Literature

Abstract Anastomotic bleeding is well known complication after gastrointestinal resection and anastomosis procedures. The percentage of patients experiencing this complication is between 0.5% to 9.6%. Delayed postoperative anastomotic bleeding is even more rare, herein, we report a case of pseudoaneurysm of right external iliac artery with arteriocolonic fistulae in a patient who underwent open right hemicolectomy and presented as delayed postoperative anastomotic bleeding-a complication never reported before related to this procedure.

Never reported complication of open right hemicolectomy-right external iliac artery pseudoaneurysm with arterio colonic fistulae presenting as delayed postoperative anastomotic bleeding: a case report and review of literature

Anastomotic bleeding is well known complication after gastrointestinal resection and anastomosis procedures. The percentage of patients experiencing this complication is between 0.5% to 9.6%. Delayed postoperative anastomotic bleeding is even more rare, herein, we report a case of pseudoaneurysm of right external iliac artery with arterio-colonic fistulae in a patient who underwent open right hemicolectomy and presented as delayed postoperative anastomotic bleeding-a complication never reported before related to this procedure.

Life-threatening bleeding after pelvic exenteration for recurrent cervical cancer: endovascular management of ruptured external iliac artery pseudoaneurysm: a case report and literature review

Background: Clinically, postoperative pseudoaneurysm rupture following gynecological radical surgeries is a very rare but fatal complication. The occurrence of this fatal complication should arouse the concern of clinicians. Accurate diagnosis and immediate treatment is needed for this emergency condition. Case: A 56-year-old women had life-threatening bleeding caused by ruptured external iliac artery pseudoaneurysm five months after pelvic exenteration for recurrent cervical squamous carcinoma. Emergency left external iliac artery covered stent placement was successfully performed to control the massive bleeding. The patient recovered well and no complication was observed during a three month follow-up period. Conclusions: In some cases, endovascular techniques may be an attractive alternative.

S2692 Abscess-Enteric Fistula of Failed Kidney Transplant Presenting With Gastrointestinal Bleeding

Introduction: Lower gastrointestinal (GI) bleeding is a common occurrence, with the vast majority of cases being due to diverticula, vascular ectasias, cancers, and hemorrhoids. In rare cases, a large vessel can form a fistula with the GI tract, causing bleeding. We present a case where an abscess surrounding a failed transplant kidney eroded into the external iliac vein and presented as a slow lower GI bleed. Case Description/Methods: A 65-year-old man with a failed renal transplant and known colovesicular fistula presented with hypotension. Labs showed a significant leukocytosis, an elevated lactate, and a hemoglobin of 6.3 g/dL. He was started on broad spectrum antibiotics, and then developed intermittent episodes of small-volume bright red blood per rectum. The patient had an upper endoscopy and colonoscopy one month prior for GI bleeding which had not identified a source. Computed tomography angiography of the abdomen and pelvis revealed a fistulous communication between the sigmoid colon and a multiloculated right lower quadrant collection (Figure). The collection encased the transplanted kidney and right iliac vasculature. Extraluminal extravasation of intra-arterial contrast was noted, concerning for either active arterial bleed or pseudoaneurysm. The patient underwent emergent exploratory laparotomy which revealed a necrotic transplant kidney densely adhered to the surrounding colon and a right external iliac artery pseudoaneurysm. Bleeding was noted from a defect in the right external iliac vein. The kidney was removed, the pseudoaneurysm was stented, and the vein defect was oversewn. Unfortunately, the patient had a complicated post operative course and died. Discussion: In patients with evidence of small-volume rectal bleeding but a clinical picture concerning for a more significant bleed, cross-sectional imaging can be necessary to make the appropriate diagnosis. In this case, imaging identified the abscess-enteric fistula, and laparoscopy revealed that the bleeding was due to a defect in the iliac vein. Abscess-enteric fistulas are associated with post-surgical states or small localized perforations. This patient likely developed a microperforation that infected the failed transplant kidney, creating an abscess which eroded into the iliac vein. GI bleeding was only intermittent and a source was not identified on prior luminal imaging, possibly due to the small size of the fistula tract. This pathology is unfortunately not amenable to endoscopic intervention and often requires surgery.Figure 1.: Computed tomography angiography of the abdomen and pelvis with a multiloculated right lower quadrant collection encasing a transplanted kidney and right iliac vasculature.

A Large External Iliac Artery Pseudoaneurysm Encountered During Hip Surgery

A 76 year old man presented with left peri-prosthetic hip infection with previous pelvic irradiation for rectal cancer. Hip dislocation during a Girdlestone procedure resulted in a significant bleed controlled by hip relocation and packing. Angiography revealed an external iliac artery pseudoaneurysm (A; arrow indicates origin of pseudoaneurysm from the external iliac artery). This was excluded by a covered stent (B; arrows [Viabahn 8 mm/10 cm; WL Gore & Associates, Flagstaff, AZ, USA]). After removal of the infected metal, the wound healed using vacuum assisted closure. The causative organism (Esherichia coli) was treated with eight weeks of meropenem in hospital.Image 1

A novel case of a pseudoaneurysm due to thermal injury from a cement hip spacer

Vascular injuries sustained during total hip replacements are associated with life- and limb-threatening complications. In the present report, we have described a novel vascular injury of an external iliac artery pseudoaneurysm repaired with an interposition vein graft. The vascular injury had been caused by heat from the curing process of a nearby cement hip spacer. During the curing process of bone cement, in vivo temperatures of ≤70°C can be reached, with such temperatures creating the potential for vascular injury. This case highlights the importance of limiting the exposure of surrounding neurovascular structures to bone cement to reduce the risk of thermal injury.

Complex management of ruptured mycotic external iliac artery pseudoaneurysm into historic transplant kidney: a combined open and endovascular approach.

Complex management of ruptured mycotic external iliac artery pseudoaneurysm into historic transplant kidney: a combined open and endovascular approach.

1664 A Herald Bleed: A Case Report of an Aortoenteric Fistula Causing an Acute Lower Gastrointestinal Bleed

INTRODUCTION: Aortoenteric fistula (AEF) is a rare, life-threatening condition with an incidence of 0.007/million. Primary AEF arises de novo, secondary AEF (SAEF) occurs following abdominal aortic aneurysm (AAA) repair. Majority of AEF’s involve the duodenum, due to proximity to the aorta. It may present as an exsanguinating herald GI bleed, associated with high mortality rates. SAEF has a 45.8% mortality rate in the first month. CASE DESCRIPTION/METHODS: A 66-year-old female presented with sudden onset of large volume bright red blood per rectum (BRBPR). She denied any prior episodes of GI bleed, alcohol or NSAID use and had never had prior endoscopy. She mentioned cholecystectomy and hysterectomy as her only surgical interventions. On examination she was hemodynamically unstable, lethargic and had a midline abdominal scar. Digital rectal exam showed BRBPR. Her lab workup showed: Hgb 9.5, Hct 29%, platelets 147000, INR 1. An emergent EGD was negative. Colonoscopy showed a 5 cm, pulsatile submucosal mass with an actively bleeding ulcerated area. Epinephrine was injected for temporary hemostasis. A hemoclip was placed to mark the site for potential embolization, as the lesion was not amenable for definitive endoscopic intervention. A stat CT angiogram of the abdomen and pelvis revealed a large left external iliac artery (LEIA) pseudoaneurysm in the region of the clip placed during colonoscopy. Vascular surgery emergently placed a LEIA stent. It appeared the patient had an open aorto-bi-iliac bypass 15 years ago for a AAA which resulted in the development of SAEF. She did well post operatively. DISCUSSION: AEF is important to consider in older patients who present with large volume hematochezia. The presence of prior signs of abdominal surgery should raise suspicion for SAEF as it is difficult to diagnose because of its rarity. The commonest symptom of SAEF is gastrointestinal bleeding. Other symptoms are fever, sepsis, pulsating abdominal or groin mass, abdominal or back pain. CT and GI endoscopy are frequently used for diagnosis. Without treatment AEF often proves to be fatal. Treatment of AEF includes volume resuscitation, antibiotics, and aortic repair. Given our patient's bleed with tenuous clinical status, large body habitus, medical comorbidities, poor functional status as well as previous aorto-bi-iliac bypass, decision was made to approach the pseudoaneurysm endovascularly, despite possible presence of vessel-enteric fistula, as she was deemed unstable for an open approach.

Endovascular Interventions in Vascular Complications After Simultaneous Pancreas and Kidney Transplantations: A Single-Center Experience.

BackgroundVascular failures are serious complications in pancreas transplantation. Open surgery is a reliable and quick intervention method, but it carries a risk of infection and bleeding. Endovascular procedures are rare among patients after a SPK, but are becoming more frequently used. One of the main risks of the endovascular approach is that the renal function impairment caused by contrast agent.Material/MethodsWe performed a retrospective analysis of 200 transplanted pancreases at our center over the last 14 years. The analyses included those patients after pancreas transplantation who required the most challenging vascular interventions and ones that were non-standard for the procedure.ResultsSevere vascular conditions requiring endovascular intervention were observed in 3% of SPKs. In one retransplanted patient, there was an acute ischemia of the lower extremity due to the narrowing of the common iliac artery following a previous transplantectomy, above the new pancreas graft anastomoses. In another patient, local inflammation led to the disruption of the external iliac artery on the level of transplantectomy, caused severe bleeding, and we had to implement a stent-graft to reconstruct the iliac artery wall. A third patient had a pseudoaneurysm demanding further treatment with a stent-graft implemented into the femoral artery due to a pseudoaneurysm of the right external iliac artery.ConclusionsIntravenous interventions in patients with a transplanted or retransplanted pancreas are safe and feasible. It is a technically demanding procedure, but the risk of kidney graft function deterioration, as well as of bleeding due to the high dose of heparin used, is lower than with open vascular surgery.

Endovascular Repair of an Iliac Artery Pseudoaneurysm Using a Surgeon-Reconstructed Prosthetic Graft and a Bare Metal Stent.

Iliac artery aneurysms are usually asymptomatic. Herein, we report a novel strategy for the repair of a pseudoaneurysm involving the external iliac artery using a conventional artificial graft and bare metal stent. A 76-year-old male patient presented with severe resting pain and right foot discoloration. Computed tomography angiography revealed a right distal external iliac artery pseudoaneurysm, with severe calcified occlusion at the right common and superficial femoral arteries. After exposing the right femoral artery, long-segment endarterectomy and patch angioplasty with the ipsilateral greater saphenous vein were performed. Before the completion of patch angioplasty, a surgeon-modified 8-mm expanded polytetrafluoroethylene (ePTFE) graft was inserted for complete pseudoaneurysm repair. If a commercial covered stent is not available, minimally invasive endovascular repair can be safely performed using a surgeon-modified ePTFE graft and bare metal stent.

A successful hybrid operation for life-threatening hemorrhagic shock secondary to an iatrogenic ruptured pseudoaneurysm of the external iliac artery following percutaneous arterial access

Intravascular treatments such as arterial embolization and resuscitative endovascular balloon occlusion of the aorta are being increasingly performed in emergency cases, in addition to the increasing use of arterial access as an intensive care monitoring tool. Thus, arterial access-related complications are being commonly reported. A 40- year-old man with renal artery stenosis underwent renal artery stent placement via the left inguinal puncture approach. After the procedure, his groin was manually compressed to hemostasis for 30 min. He unexpectedly developed shock the following day, and computed tomography revealed a ruptured pseudoaneurysm of the left external iliac artery (EIA) following iatrogenic vascular trauma owing to an inappropriately performed groin puncture. We initially controlled the hemorrhage using endovascular balloon occlusion of the left EIA. Subsequently, the injured EIA was repaired using a direct suture. The postoperative course was uneventful. Herein, we evaluated the causes of iatrogenic complications and the effectiveness of our treatment strategy.

Complication of a bilateral acetabular fracture after multiple surgeries and 30 years of evolution. Presentation of a case

Bilateral acetabular fracture, open reduction and internal fixation, without achieving anatomical reduction; it required placement of short-term total prostheses, both cemented. We made a revision of both left hip components in the eighth year because of loosening of the cup and stem, with uncemented components. The femur evolved satisfactorily, but the acetabulum required six subsequent revisions, with bone grafts and placement of metal reinforcements, initially very stable, but with screw rupture and lack of osseointegration of both implants and grafts at 12 and 18 months in the different surgical events. She developed pseudoaneurysm of the left external iliac artery, treated by a vascular surgeon; it got complicated with local infection first and later, deep infection of the left hip by Staphylococcus aureus. The implants were removed from the iliac and polymethylmethacrylate with antibiotics was used to fi ll the large bone defect while the infection was being controlled, ending with a saddle rescue prosthesis (Link, Hamburg). It currently has a good function, without pain, but with limited mobility, especially fl exion. The right hip has only been checked once; the acetabular cup began to migrate cephalically and vertically, but without losing stability, shortly after the loosening of the left one; it never developed femoral stem involvement, allowing acceptable function and being «her good leg» during the time of the left hip dysfunction. It was reviewed by placing a structural bone graft with two femoral heads from a corpse and cementing a new cup. The patient’s recovery has been very good, returning to an active life in which she is self-suffi cient in all her daily activities; uses a crutch with her right hand, drives a van, is pain-free.

External iliac artery pseudoaneurysm in patient with history of failed kidney transplant

External iliac artery pseudoaneurysm in patient with history of failed kidney transplant

Giant external iliac artery pseudoaneurysm following percutaneous coronary intervention: a rare case

Corresponding author: Suleyman Surer, M.D. Bursa Yuksek Ihtisas Egitim ve Arastirma Hastanesi Kalp ve Damar Cerrahisi Klinigi, 16330 Yildirim, Bursa, Turkey. Tel: +90 505 494 08 28 e-mail: drsuleyman1@hotmail.com Invasive cardiac interventions have an important role in development of lower extremity arterial pseudoaneurysms. A 27-year-old male patient presented with the complaint of difficulty in walking following the discharge from the hospital after a successful emergent percutaneous transluminal coronary angioplasty and stent implantation for acute myocardial infarction in a cardiology clinic. Arterial Doppler ultrasonography showed a 90 mm of pseudoaneurysm in the right external iliac artery. Closure of aneurysm by compression and thrombin injection under ultrasonographic guidance was planned, but failed. Aorto-femoral bypass was performed eventually.

Delayed massive hemorrhage due to external iliac artery pseudo-aneurysm and uretero-iliac artery fistula following robotic radical cystectomy and intracorporeal Studer pouch reconstruction: endovascular management of an unusual complication

We report a very unusual complication of uretero-iliac artery fistula that developed following robotic radical cystectomy (RARC), bilateral extended pelvic lymph node dissection and intracorporeal Studer pouch reconstruction. Our patient was a 54-year-old male who was admitted 1 month after undergoing robotic surgery due to intermittently occurring massive transurethral bleeding necessitating blood transfusion that stopped by itself. Angiography showed a right external iliac artery pseudo-aneurysm and a fistula tract between the pseudo-aneurysm and Wallace type ureteral anostomosis that was successfully treated by an angiographic endovascular stent insertion at this level. Uretero-iliac artery fistula might occur following RARC, bilateral extended pelvic lymph node dissection and intracorporeal Studer pouch reconstruction leading to intermittently massive transurethral bleeding. Angiography and stenting are important for diagnosis and successful treatment of this rare entity.

Rupture of the Left External Iliac Artery and Right Groin Pseudoaneurysm Formation following Angioplasty in a Patient with Neurofibromatosis Type 1 and Undiagnosed Bilateral Phaeochromocytoma

Neurofibromatosis type 1 (NF1) is a genetic condition, which affects 1 in every 3000 births. Patients with NF1 are at increased risk of a variety of vascular abnormalities. This report presents the case of a 60-year-old male with NF1 who suffered a left external iliac rupture and a right pseudoaneurysm following angioplasty. In addition, these were further complicated by previously undiagnosed, bilateral phaeochromocytomas. The inherent weakness in vessel wall architecture found in NF1 coupled with the hypertension evident during and after the procedure contributed to haemorrhage and pseudoaneurysm formation. Caution must be taken in such patients when considering vascular intervention.

Life-threatening bleeding after pelvic lymphadenectomy for cervical cancer: endovascular management of ruptured false aneurysm of the external iliac artery

Late rupture of external iliac artery pseudo-aneurysm is an uncommon complication in patients who undergo extensive gynecologic radical surgeries. A 28-year-old woman with stage IB cervical cancer underwent pelvic lymphadenectomy and extrafascial trachelectomy. Two months after surgery, massive bleeding from ruptured pseudo-aneurysm of the external iliac artery occurred. Endovascular management with covered stent placement was feasible and safe to stop bleeding.

Post-Catheterization External Iliac Artery Pseudoaneurysm, Use of Uncovered Stent in Emergency Endovascular Repair

Post-Catheterization External Iliac Artery Pseudoaneurysm, Use of Uncovered Stent in Emergency Endovascular Repair

Endovascular Repair of Symptomatic Renal Transplant Site Pseudoaneurysm

This article reports a patient with a symptomatic external iliac artery pseudoaneurysm at a prior transplant nephrectomy site who underwent successful repair with percutaneous endovascular placement of a covered stent. Endovascular treatment with a covered stent is a safe and effective alternative to open surgery in the treatment of a symptomatic pseudoaneurysm arising from a transplant nephrectomy site.

Ruptured Pseudoaneurysm of the External Iliac Artery in an Advanced Cervical Cancer Patient Treated by Endovascular Covered Stent Placement

The formation of pseudoaneurysms in patients with gynecologic malignancies is rare. We describe a patient with locally advanced cervical cancer who had life-threatening rectal bleeding due to a ruptured pseudoaneurysm of the right external iliac artery, which was successfully treated by emergent endovascular covered stent placement. This 56-year-old woman had received concurrent chemoradiation, salvage hysterectomy and systemic chemotherapy for advanced cervical cancer. About 25 months after her diagnosis of cervical cancer, she suffered from acute life-threatening rectal bleeding. Angiography revealed active extravasation from a pseudoaneurysm of the right external iliac artery. A covered stent was placed across the pseudoaneurysm via an endovascular approach to stop the bleeding. The patient recovered well without any sequelae. We believe that this technique might also be useful in other irradiated gynecologic cancer patients, especially when direct surgical repair is difficult to perform due to pelvic irradiation or tumor recurrence.