Endovascular treatment for iliac artery pseudoaneurysm with arteriovenous fistula after abdominal aortic aneurysm open repair

A 71-year-old man underwent an abdominal aortic aneurysm open repair eleven years ago. The operation was performed with an aorto-bi-iliac Dacron graft. Three years later, the patient developed a right iliac artery occlusion. Correction was made with a femoral-to-femoral bypass. The patient presented in the emergency department with acute onset of orthopnea and exertional dyspnea. A physical examination indicated an abdominal thrill and murmur, jugular venous distention, cardiomegaly, and diminished distal pulses in both legs. His vital signs were within normal limits, and biochemical analysis revealed no significant abnormalities. A contrast-enhanced computed tomography angiography (CTA) scan revealed a left iliac artery anastomotic pseudoaneurysm complicated with an ilio-iliac arteriovenous fistula. The femoral-to-femoral bypass and the lower limb arteries were patent (Figures 1 and 2). An intra-operative arteriography confirmed the false aneurysm and arteriovenous fistula to the left iliac vein. The patient underwent endovascular repair with iliac extender grafts (‘‘Medtronic Talent 16612675; 146126105 and 16612675’’) in the left iliac artery, sealing the fistula. Control arteriography revealed no residual fistula, no endoleak and adequate lower limb perfusion. There were no postoperative complications, and the patient was discharged five days after surgery. His congestive heart failure symptoms disappeared. The follow-up CTA scan demonstrated no fistula, no endoleak and adequate lower limb perfusion (Figure 3). DISCUSSION