An Ilio-iliac Arteriovenous Fistula Following Spontaneous Rupture of a Right Common Iliac Artery Aneurysm

Abstract

The formation of an ilio-iliac arteriovenous fistula is a potentially lethal complication of common iliac artery aneurysm presentations. Whilst trauma predominantly accounts for the majority, spontaneous rupture of a common iliac artery aneurysm into an adjacent venous structure accounts for a small subset of patients. Urgent surgical intervention is warranted with the aim to restore arterial continuity and ideally, closure of the fistula. This case study describes the endovascular management of a spontaneous ilio-iliac arteriovenous fistula following rupture of a common iliac artery aneurysm into an adjacent vein.

Hepatorenal syndrome from an ilio-iliac arteriovenous fistula: A rare complication from an endoleak

“…2,6 These findings do not occur consistently or uniformly, and may be present in less than half of patients. 2,5,6 Less common symptoms include limb ischemia, acute liver failure, paradoxical emboli, and intestinal angina. 2,6 Ilio-iliac AVF leads to profound physiologic changes with a reduction in afterload creating a steal-like phenomenon where blood is shunted from arterial system to venous system.…”

“… 4 Spontaneous formation is the rarest etiology of ilio-iliac AVFs, occurring in only 16% of cases, with the remainder typically resulting from trauma, malignancy, or iatrogenesis. 5 , 6 The clinical presentation of ilio-iliac AVFs can vary and can include rapid-onset high output cardiac failure, a pulsatile abdominal or pelvic mass, unilateral leg edema, and acute kidney injury. 2 , 6 These findings do not occur consistently or uniformly and could be present in fewer than one half of patients.…”

“… 2 , 6 These findings do not occur consistently or uniformly and could be present in fewer than one half of patients. 2 , 5 , 6 Less common symptoms include limb ischemia, acute liver failure, paradoxical emboli, and intestinal angina. 2 , 6 …”

“…In recent years, the management of iliac aneurysms and related pathologies (ie, AVF) has shifted from open to endovascular repair owing to the lower morbidity and mortality. 1 , 5 Similar to the repair of common iliac aneurysms, the endovascular repair of ilio-iliac AVFs was initially approached with embolization of the internal iliac artery, followed by iliac stent exclusion. The advent of iliac branch devices has offered an alternative method for successful ilio-iliac AVF repair with preservation of pelvic perfusion.…”

“…Although exclusion of the fistula without direct repair did leave the possibility of a future type II endoleak, it is unlikely that the low pressure venous system will cause aneurysm sac expansion. 5 However, close follow-up is necessary and, in the setting of a persistent leak, further intervention might be warranted. 11 The present case illustrates the importance of including AVFs in the differential diagnosis of patients presenting with symptoms of high output heart failure in the setting of aneurysmal disease.…”