A novel endovascular technique in the management of a large internal iliac artery aneurysm associated with an arteriovenous fistula

The Successful Treatment of an Ilio-Iliac Fistula and Aneurysms Affecting the Abdominal Aortic and Iliac Arteries via Endovascular Stent Graft Repair

“…1,7,8 Open techniques have been proposed but these cases involve high risks of bleeding, wound infection, and mortality especially if the patient has significant comorbidity. 9 In addition, the risk of mortality might be greater in cases involving concomitant pulmonary embolisms. 1 Furthermore, open surgery increases the risk of bleeding and can make it difficult to use coumadinization to treat pulmonary embolisms.…”

“…10 There are various limitations on the use of endovascular repair, which are related to the patient's condition, the anatomical suitability of the technique, and the availability of the necessary equipment. 1,9 For example, if the external iliac artery is affected by arteriosclerosis obliterans, this technique involves the risk of intraluminal obstruction. In addition, the problem in the management of large aortoiliac aneurysms is that may produce compression symptoms in the surrounding tissues.…”

“…To the best of our knowledge, there has only been one report about the endovascular management of an ilio-iliac AVF caused by a large internal iliac artery aneurysm. 9 In the latter case, endovascular treatment involving the implantation of stent grafts into the iliac vein (to cover a fistulous channel) and the embolization of the native external iliac artery (inflow) were performed via simultaneous venous and arterial approaches. 9 However, there have not been any reports about the endovascular management of ilio-iliac AVF caused by aortoiliac aneurysms.…”

“…9 In the latter case, endovascular treatment involving the implantation of stent grafts into the iliac vein (to cover a fistulous channel) and the embolization of the native external iliac artery (inflow) were performed via simultaneous venous and arterial approaches. 9 However, there have not been any reports about the endovascular management of ilio-iliac AVF caused by aortoiliac aneurysms. Open surgery would have put our patient at high risk of mortality or morbidities.…”

“…In a previous case, continuous pressure from an embolized internal iliac artery aneurysm led to the development of venous thrombosis, and venous stenting has been shown to be an effective treatment in these circumstances. 9,11,12 In our case, we used a relatively long leg of the stent graft on the venous side. This was because the site of the AVF could not be pinpointed accurately, so that it was intended to block the venous side as widely as possible and to avoid obstruction due to pressure from the iliac aneurysm.…”