Life-threatening bleeding after pelvic lymphadenectomy for cervical cancer: endovascular management of ruptured false aneurysm of the external iliac artery

Abstract

Late rupture of external iliac artery pseudo-aneurysm is an uncommon complication in patients who undergo extensive gynecologic radical surgeries. A 28-year-old woman with stage IB cervical cancer underwent pelvic lymphadenectomy and extrafascial trachelectomy. Two months after surgery, massive bleeding from ruptured pseudo-aneurysm of the external iliac artery occurred. Endovascular management with covered stent placement was feasible and safe to stop bleeding.

Delayed massive hemorrhage due to external iliac artery pseudo-aneurysm and uretero-iliac artery fistula following robotic radical cystectomy and intracorporeal Studer pouch reconstruction: endovascular management of an unusual complication

“…9 On the other hand, Ricciardi and colleagues reported a late rupture of external iliac artery pseudo-aneurysm that occurred 2 months after surgery in a patient who underwent pelvic surgery and pelvic lymphadenectomy for cervical cancer. 5 This case was also successfully treated with endovascular stent placement.…”

“…5,6 Extra iliac artery pseudo-aneurysm and rupture following renal transplantation and hip prosthesis have also been reported. 7,8 There is little data on pseudo-aneurysms of the pelvic vessels, particularly following major pelvic surgeries for cancer.…”

“…5 Our patient did not undergo preoperative or postoperative chemotherapy and/or radiotherapy that might have led to a pseudo-aneurysm. He is a relatively young person for having underlying atherosclerosis; however, he was a heavy smoker and this may have caused a pseudo-aneurysm at the level of the iliac artery.…”

Pseudoaneurisma gigante crónico compresivo de arteria ilíaca externa izquierda secundario a herida de arma de fuego

“…La terapia endovascular tiene una morbimortalidad menor que la cirugía convencional con buenos resultados a mediano plazo, por lo que es una alternativa que hay que tener en cuenta en pacientes con elevado riesgo quirúrgico o antecedentes de cirugía abdominal previa 6 . Utilizar un SF para la exclusión de pseudoaneurismas se realiza actualmente para reemplazar la reparación quirúrgica abierta 7 . Si el cuello del pseudoaneurisma es ancho es preferible utilizar SF o la opción quirúrgica, debido al elevado riesgo de embolización de los coils o el material embolizante utilizado.…”

Ruptured external iliac artery pseudoaneurysm following surgery for ovarian cancer: A case report and literature review

“…In all of the previously reported cases, the patients underwent lymphadenectomy or radiotherapy around the location of the pseudoaneurysm and experienced complications such as infection, fistula or cancer recurrence at the time of pseudoaneurysm rupture. [1][2][3][4][5][6][7] Previous reports suggest that lymphadenectomy or radiotherapy can cause microscopic injury to the artery. Furthermore, the vascular wall becomes brittle because of infection, fistula or cancer recurrence, which ultimately leads to the formation and eventual rupture of the pseudoaneurysm.…”