Internal Iliac Artery Pseudoaneurysm Research Articles

Diagnostic and therapeutic strategies for vascular complications after renal transplantation: a single-center experience in 2,304 renal transplantations.

Vascular complications after renal transplantation are one of the serious surgical complications, which can affect the transplantation outcome and even endanger life if not treated properly. We performed a retrospective analysis of the 2,304 renal transplantations procedures completed between the period of Jan., 2015 and Jan., 2022, which consisted of 1,658 male patients and 646 female patients. Among the above cases, there were 54 cases of vascular complications after renal transplantation, the incidence of vascular complications in our study was 2.34% (54/2,304), the most common vascular complication was transplanted renal artery stenosis (TRAS, n = 36), followed by external iliac artery dissection (n = 5), renal artery rupture (n = 4), renal vein thrombosis (n = 3), renal artery thrombosis (n = 2), renal artery dissection (n = 1), renal artery pseudoaneurysm (n = 1), and internal iliac artery pseudoaneurysm (n = 1), and renal artery kinking (n = 1). 40 patients were treated by percutaneous transluminal angioplasty (PTA), including 3 balloon catheter dilatation and 37 endovascular stentings, and 14 underwent open surgery. Eventually, 9 patients had graft nephrectomy, resulting in an overall treatment rate of 81.5%. Most vascular complications can be treated satisfactorily with PTA. However, the overall treatment of renal artery rupture, thrombosis, renal artery kinking, and other complications is poor, and the rate of transplanted renal loss is high.

Postpartum Hemorrhage Resulting from Internal Iliac Artery Pseudoaneurysm

We describe a case of internal iliac artery pseudoaneurysm in a 38-year-old woman with postpartum hemorrhage following uterine artery ligation and uterine rupture repair. A 38-year-old female without any comorbid conditions or diseases who had previously given birth with a normal vaginal delivery was admitted to an external healthcare center with pain. The patient presented to our hospital on the 7th postoperative day with abdominal and side pain. We diagnosed the patient with ultrasonography and CT-angiogram imaging and she was treated with selective embolization. On the second day following the procedure, a regression in the previously identified hydronephrosis was observed using renal ultrasonography. The patient was discharged on the 14th day of hospitalization when she was clinically stable. Patients presenting with abdominal pain and hemorrhage after cesarean sections should be carefully evaluated for the possibility of uncommon complications, especially pseudoaneurysms, preferably with a multidisciplinary approach.

The role of angioembolization in the management of hemorrhagic urovascular emergencies: Retrospective Cohort Study

Introduction: Transarterial embolization is an effective method in the management of hemorrhagic vascular emergencies irrespective of its etiology. The aim of this study is to evaluate the role of angioembolization in the management of urovascular bleed and to evaluate the morphological and functional impact in the embolized organ in the medium-term follow-up. Materials and Methods: The hospital records of 11 patients with 12 renal units and two patients with hematuria of bladder origin who underwent angioembolization from the period of October 2012 to October 2015 were retrospectively reviewed. Data on clinical indication, technique, site, and type of bleeding were recorded. The outcome measures such as success rate, preprocedural requirement of blood transfusion, and periprocedural complications were analyzed. Results: Indications for angioembolization included blunt renal trauma (2), metastatic renal cell carcinoma (1), postpercutaneous nephrolithotomy (3), postpercutaneous nephrostomy (1), angiomyolipoma (2), renal biopsy (2), postpartial nephrectomy (1), cervical cancer with intractable radiation cystitis (1), and postradical cystectomy with internal iliac artery pseudoaneurysm (1). Out of these, two patients had secondary bleed and required a second session of angioembolization. The meantime between the first presentation and embolization was 34.46 h (4–96 h). Mean preprocedural blood transfusion requirement was 4.9 units (3–8 units). None of these patients required postprocedural blood transfusion. There was no serious postprocedural complication. There was no incidence of hypertension or renal impairment in the medium-term follow-up. Conclusion: The procedure carries low morbidity and a high rate of preservation of organ function. Hence, it should always be considered in the management of postoperative bleeding before embarking on surgical exploration.

“Internal iliac artery pseudoaneurysm communicating with orthotopic neobladder:” A rare complication of radical cystectomy

Iliac artery–orthotopic neobladder fistulas are very rare following radical cystectomy. Only two cases are reported in literature. We report a case of a 58-year-old male who had undergone radical cystectomy with orthotopic neobladder surgery about 2 months earlier at our institute and now presented with a history of hematuria and pain abdomen. He was found to have a pseudoaneurysm of the right internal iliac artery communicating with the orthotopic neobladder. Angio-embolization of the right internal iliac artery resolved the problem.

Posttransurethral Resection of Prostate Recurrent Life Threatening Hematuria: A Rare Cause.

Herein, we present a case report of post-TURP (transurethral resection of prostate) recurrent severe hematuria due to right internal iliac artery pseudoaneurysm protruding into bladder lumen. A 60-year-old male presented with recurrent massive hematuria following TURP done elsewhere 15 days before. His hemoglobin was 4 gm/dL after 13 units of blood transfusion and repeated clot evacuations. His blood urea, serum creatinine, and coagulation profile studies were normal. Ultrasonography of abdomen showed multiple clots in the bladder. Cystoscopy revealed clots with a right posterolateral wall unhealthy area. After stabilizing the patient, contrast enhanced CT urography revealed intravesical aneurysm. CT angiography showed pseudoaneurysm of a branch of internal iliac artery protruding into urinary bladder lumen. We referred patient to selective embolization of the lesion but the procedure was unsuccessful. At last, ipsilateral internal iliac artery ligation relieved hematuria. But on postoperative day 2, patient suddenly collapsed and deceased, presumably due to cardiomorbidities.

Pseudoaneurysm of the Internal Iliac Artery: a Rare Cause of Bilateral Lumbosacral Plexopathy

Pseudoaneurysms of the internal iliac artery are uncommon and are usually associated with trauma. Rarely, they expand subclinically for years and cause significant compression of adjacent vital structures. We report an unusual case of delayed onset bilateral lumbosacral plexopathy resulting from direct compression due to a right internal iliac artery pseudoaneurysm. The neurological symptoms of the patient began 2 years after a stab injury to the right gluteal region. To the best of our knowledge, this is the first report of bilateral lumbosacral plexopathy secondary to a solitary internal iliac artery pseudoaneurysm that manifested clinically 2 years after the injury. This report illustrates how a pseudoaneurysm of the internal iliac artery (an extraspinal pathology) has the potential to cause lumbosacral plexopathy, and describes relevant imaging findings.

Internal Iliac Pseudoaneurysm Rupture Attributed to Perforated Hartmann’s Pouch Diagnosed on CT

Rupture is a rare but disastrous complication of an arterial aneurysm. Intraabdominal abscess in association with iliac artery aneurysm is uncommon but can predispose to aneurysm rupture. We report the Computed Tomography (CT) findings of an internal iliac artery pseudoaneurysm formed by a pelvic abscess attributed to the perforation of the patient’s Hartmann’s pouch. Rupture of the pseudoaneurysm resulted in the patient’s death.

Internal iliac artery pseudoaneurysm in an infant following bone marrow trephine biopsy

Internal iliac artery pseudoaneurysm in an infant following bone marrow trephine biopsy

An Unusual Case of Acute Foot Drop Caused by a Pseudoaneurysm

Lower extremity neurologic symptoms are a common presenting problem. Here we report the case of a 73-year-old man who developed acute right foot pain and foot drop. History, physical examination, and electrodiagnostic studies were consistent with a lumbosacral plexopathy. Imaging studies revealed an internal iliac artery pseudoaneurysm, a rare cause of acute foot drop.

Internal Iliac Artery Pseudoaneurysm

This report describes an unusual case of lumbosacral plexopathy resulting from internal iliac artery pseudoaneurysm. A 50-yr-old woman presented with multiple penetrating trauma to the thorax, abdomen, and left buttock. Several weeks after the injury, severe sciatica and motor dysfunction developed in her left leg. Progressively worsening pain was followed by left foot drop. An electrodiagnostic evaluation suggested a lower lumbosacral plexopathy. Magnetic resonance imaging showed a hematoma extending adjacent to the left lumbosacral plexus. Computerized tomographic angiography revealed a left internal iliac artery pseudoaneurysm. The pseudoaneurysm was excised surgically. In the early postoperative period, the patient reported total relief of pain. Her motor function recovered gradually over several weeks; however, some residual weakness of foot dorsiflexion persisted. With this case presentation, we underscore that an arterial pseudoaneurysm should be remembered as an etiologic possibility of lumbosacral plexopathy and sciatica, especially in patients with history of iatrogenic or accidental trauma. An increased awareness of this rare cause of sciatica and lumbosacral plexopathy may enable early intervention alternatives.

Internal Iliac Artery Pseudoaneurysm Following Renal Transplant Biopsy Successfully Treated With Endovascular Stenting and Thrombosis: A Case Report

A 49-year-old man underwent living donor renal transplantation in November 2005. The transplant renal artery was anastomosed to the right internal iliac artery with an end-to-end anastomosis. The patient achieved immediate graft function and the allograft was normally perfused. Seven weeks later, renal allograft function deteriorated with a serum creatinine level increased to 244 μmol/L. An ultrasound scan revealed adequate perfusion to the kidney and the absence of hydronephrosis. A transplant biopsy revealed Banff IB rejection, which was treated with high-dose prednisolone. Following biopsy, the patient’s renal function rapidly deteriorated with a serum creatinine level increased to 627 μmol/L, requiring hemodialysis. A computed tomography (CT) angiogram demonstrated a 6-cm diameter pseudoaneurysm arising from the internal iliac artery with absence of kidney perfusion. The aneurysm was accessed percutaneously with a 4-F catheter and 1000 U of human thrombin injected, resulting in partial thrombosis of the pseudoaneurysm. A balloon expandable covered metal stent was then placed across the site of the transplant renal artery anastomosis, resulting in successful occlusion of the aneurysm. Intrarenal blood flow was established by dilating 2 intrarenal branches with 3-mm diameter balloons. The serum creatinine level started to decrease within 24 hours of the procedure and renal function improved rapidly to a level achieved immediately after transplantation. Three months later the patient had a well-functioning allograft with a serum creatinine level of 176 μmol/L, follow-up CT scan demonstrated good perfusion of the transplanted kidney with no further change in the pseudoaneurysm. At 12 months follow-up the patient remains with a well-functioning allograft.

Radiculopathy Caused by Internal Iliac Artery Pseudoaneurysm Managed with Endovascular Embolization

The authors describe a case of pseudoaneurysm arising from internal iliac artery presented with radiculopathy mimicking the symptoms of lumbar disc disease or spinal cord tumor. Among the several preoperative evaluation including CT, MRI, electrophysiologic study and ultrasonography, important diagnostic clue was obtained by ultrasonographic findings of turbulence flow at the core of partially enhanced mass in the pelvic cavity. The patient was managed with endovascular coil embolization successfully. The current case makes us remind that assessment of neurological symptoms on lower extremity should include consideration of extraspinal cause in pelvis.

Treatment of Internal Iliac Artery Pseudoaneurysm by an Endovascular Approach

Pseudoaneurysms of the internal iliac artery are uncommon and are usually associated with trauma. We report the case of a 32-year-old man with a 15-day history of trauma to the abdomen and edema of the lower left limb. An arteriogram demonstrated proximal occlusion of the popliteal artery and a pseudoaneurysm in the internal iliac artery. Embolization of the pseudoaneurysm was performed using segments of guide wire that occluded the pseudoaneurysm, followed by proximal occlusion, which was accomplished using coils. An arteriogram after the procedure revealed adequate occlusion of the lesion. This association of guide wires and coils is a treatment option in cases of pseudoaneurysm of the internal iliac artery with large volumes needing to be occluded.