Single-stage Endovascular Treatment of a Penetrating Aortic Ulcer with a Concomitant “Isolated” Iliac Aneurysm

Abstract

Penetrating aortic ulcer (PAU) is an acute aortic syndrome that can proceed to life-threatening aortic dissection or even aortic rupture. Isolated iliac aneurysms are relatively rare and often asymptomatic due to their deep pelvic location but are frequently associated with high mortality with rupture. We report a case of a 68-year-old man with a symptomatic penetrating ulcer in the descending aorta and an asymptomatic right iliac aneurysm involving the common and internal iliac arteries. The patient was successfully treated by endovascular repair in a single-stage manner using stent grafts in the descending aorta and right common iliac artery after coil embolization of the right internal iliac artery. Follow-up imaging showed complete resolution of the PAU and exclusion of the right iliac aneurysm without endoleak. Aggressive endovascular treatment for a symptomatic PAU with an asymptomatic isolated iliac aneurysm is feasible and allows complete treatment of vascular pathology at a single time.