Endovascular Repair of a Spontaneous Right Common Iliac Artery—Inferior

Institutional review board approval was obtained for review of this case, and informed consent was obtained from the patient. A 56-year-old man presented with lower abdominal pain and bilateral lower extremity swelling of 1 month duration prior to admission. These symptoms were accompanied by mild dysp-nea, nausea, and intense diaphoresis. Past medical history was significant for a 10-year history of hypertension, treated by antihypertensive drugs for the past 3 years. The patient denied a history of trauma, diabetes, or previous operations. He also denied a history of connective tissue disorders or systemic anomalies, and there was no significant family history of disease. Three months prior to this admission, the patient was hospitalized for right lower quadrant abdominal pain. Computed tomography (CT) of the abdomen and pelvis at that time identified a previously unknown infrarenal abdominal aortic aneurysm (AAA; maximal diameter = 3.6 cm) with extension to both common iliac arteries. The right internal iliac artery was chronically Spontaneous rupture of an abdominal aortic oriliac aneurysm into the inferior vena cava(IVC) or iliac vein is rare, with a reported inci-dence of 3 % to 4 % of all ruptured aneurysms.1 The most common fistula site is the IVC, and the iliac and renal veins are rarely affected.1,2 It is the most frequent cause of a major abdominal arteriovenous fistula1,3; and lower extremity venous congestion, edema, abdominal bruit, congestive heart failure, widened pulse pressure, and decreased distal pulses may all occur in affected patients.1-3 In this article, we report the very rare condition of a spontaneous right common iliac artery—IVC fistula caused by an infrarenal aortoiliac aneurysm and also the successful endovascular management of this case. Most abdominal aortic aneurysms are asympto-matic, but 1 % to 4 % of cases present with a life-threatening complication. A spontaneous right common iliac artery—inferior vena cava fistula, a rare condi-tion caused by infrarenal aortoiliac aneurysm, is reported. In this case, the condition was successfully managed with primary endovascular stent-graft treatment