Spontaneous dissection of the external iliac artery due to fibromuscular dysplasia

Bei einem 45-jährigen Mann wurde im Rahmen der Abklärung einer neu aufgetretenen Claudicatio intermittens eine Spontandissektion der rechten A.iliaca externa diagnostiziert. Nach primär konservativem Vorgehen erfolgte aufgrund einer nach distal progredienten Dissektion nun die operative Sanierung, angesichts des jungen Alters des Patienten in Form einer retrograden TEA über einen Führungsdraht. Die intraoperative Angiographie zeigte ein gutes Rekonstruktionsergebnis der A.iliaca externa re. bei unauffälliger A.iliaca communis sowie ebenfalls unauffälliger infrarenaler Aorta. Histologisch fand sich ursächlich für die spontane Dissektion eine fibromuskuläre Dysplasie der Media. Postoperativ waren rechtsseitig beide Fußpulse kräftig tastbar bei einem Dopplerindex von 1,0. Nach unauffälligem postoperativem Verlauf wurde der Patient beschwerdefrei mit unbegrenzter Gehstrecke wieder nach Hause entlassen. Wenig später beklagte der Patient erneut belastungsabhängige Schmerzen des rechten Beines. Ursächlich fand sich nun eine umschriebene Stenose der A.iliaca communis rechts sowie eine retrograde Dissektion der rechten A.iliaca communis bis in die terminale Aorta reichend. Vom vorbehandelnden Heimatkrankenhaus wurde dem Patienten zunächst zu einer konservativen Therapie geraten. Der Befund ist klinisch und sonographisch seit sechs Monaten unverändert.

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Fibromuscular Dysplasia of the External Iliac Artery

Acta Chirurgica Belgica ◽

10.1080/00015458.1999.12098472 ◽

1999 ◽

Vol 99 (4) ◽

pp. 171-173

Author(s):

H. Verhelst ◽

G. Lauwers ◽

H. Schroë

Keyword(s):

Iliac Artery ◽

Fibromuscular Dysplasia ◽

External Iliac Artery

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Spontaneous Dissection of the External Iliac Artery Secondary to Golf Club Manufacturing

Vascular and Endovascular Surgery ◽

10.1177/1538574412467862 ◽

2012 ◽

Vol 47 (1) ◽

pp. 73-75 ◽

Cited By ~ 4

Author(s):

S. Yoong ◽

G. Heyes ◽

G. W. Davison ◽

R. Hannon ◽

M. E. O’Donnell

Keyword(s):

Iliac Artery ◽

External Iliac Artery ◽

Golf Club ◽

Spontaneous Dissection

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Symptomatic Fibromuscular Dysplasia of the External Iliac Artery

Annals of Vascular Surgery ◽

10.1016/j.avsg.2011.09.010 ◽

2012 ◽

Vol 26 (4) ◽

pp. 574.e9-574.e13 ◽

Cited By ~ 6

Author(s):

Neeraj Rastogi ◽

Nii-Kabu Kabutey ◽

Ducksoo Kim ◽

Alik Farber

Keyword(s):

Iliac Artery ◽

Fibromuscular Dysplasia ◽

External Iliac Artery

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Management of a spontaneous dissection of the right external iliac artery

JMV-Journal de Médecine Vasculaire ◽

10.1016/j.jdmv.2021.08.185 ◽

2021 ◽

Author(s):

S. El Hadhri ◽

M. Gueldich ◽

H. Ben Jemaa ◽

I. Frikha

Keyword(s):

Iliac Artery ◽

External Iliac Artery ◽

The Right ◽

Spontaneous Dissection

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A Rare Case of Periadventitial Fibromuscular Dysplasia in External Iliac Artery: A Short Report

EJVES Extra ◽

10.1016/j.ejvsextra.2007.10.001 ◽

2008 ◽

Vol 15 (2) ◽

pp. 12-13

Author(s):

B. Ahmed ◽

M. Abudaka ◽

A.J. Howat ◽

H. Al-khaffaf

Keyword(s):

Iliac Artery ◽

Rare Case ◽

Fibromuscular Dysplasia ◽

External Iliac Artery ◽

Short Report

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A 42-year-old woman with acute myocardial infarction

Heart ◽

10.1136/heartjnl-2017-312779 ◽

2018 ◽

Vol 104 (19) ◽

pp. 1607-1607 ◽

Cited By ~ 2

Author(s):

James K Fahey ◽

Abdul Rahman Ihdayhid ◽

Anthony John White

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Iliac Artery ◽

Fibromuscular Dysplasia ◽

External Iliac Artery ◽

List Type ◽

System A ◽

Invasive Angiography ◽

St Elevation ◽

The Right

Clinical introductionA 42-year-old woman presented with anterior ST elevation myocardial infarction. Urgent coronary angiography revealed tapering then occlusion of the distal left anterior descending (LAD) coronary artery with no flow in the distal LAD (figure 1A). Balloon angioplasty with a 2.0×8 mm balloon re-established flow into the distal LAD. An angiogram of the right external iliac artery was also performed (figure 1B).Figure 1Invasive angiography of the left coronary system (A) and the right external iliac artery (B). The coronary angiogram (A) shows tapering and then occlusion (arrow) of the distal left anterior descending coronary artery.QuestionWhich of the following explains the abnormal appearance of the external iliac artery (figure 1B)?Atherosclerosis.Concertina effect.Fibromuscular dysplasia.Perforation.Multiple aneurysms.

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A Rare Case of Periadventitial Fibromuscular Dysplasia in External Iliac Artery: A Short Report

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2007.11.003 ◽

2008 ◽

Vol 35 (3) ◽

pp. 378

Author(s):

B. Ahmed ◽

M. Abudaka ◽

A.J. Howat ◽

H. Al-khaffaf

Keyword(s):

Iliac Artery ◽

Rare Case ◽

Fibromuscular Dysplasia ◽

External Iliac Artery ◽

Short Report

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Unusual cause of intermittent claudication

VASA ◽

10.1024/0301-1526.33.4.257 ◽

2004 ◽

Vol 33 (4) ◽

pp. 257-259 ◽

Cited By ~ 3

Author(s):

Thalhammer ◽

Aschwanden ◽

Blum ◽

Labs ◽

Jaeger

Keyword(s):

Iliac Artery ◽

Similar Case ◽

Rare Event ◽

External Iliac Artery ◽

Peripheral Artery ◽

Spontaneous Healing ◽

Non Invasive ◽

Left Calf ◽

Spontaneous Dissection ◽

Leg Ischemia

Spontaneous dissection of a peripheral artery is a rare event. We report a case of a spontaneous, non-atherosclerotic and non-aneurysmal dissection limited to the external iliac artery in a 60-year-old woman who was admitted with a left calf claudication. Non-invasive examination documented signs of leg ischemia due to a floating wall dissection of the external iliac artery. After medical treatment over eight weeks the dissection membrane had been adapted to the vessel wall. A similar case of a spontaneous dissection limited to the external iliac artery, followed by a spontaneous healing has not been reported in the literature.

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Abstract P439: Fibromuscular Dysplasia Of The Iliac And Renal Arteries: A Rare Case Report And Literature Review

Hypertension ◽

10.1161/hyp.70.suppl_1.p439 ◽

2017 ◽

Vol 70 (suppl_1) ◽

Author(s):

Luyun Fan ◽

Wenjun Ma ◽

Huimin Zhang ◽

Jun Cai

Keyword(s):

Renal Artery ◽

Iliac Artery ◽

Fibromuscular Dysplasia ◽

Three Dimensional ◽

Antihypertensive Agents ◽

Artery Aneurysm ◽

External Iliac Artery ◽

Computed Tomographic Angiography ◽

First Choice ◽

Internal Iliac

Background: Iliac arterial fibromuscular dysplasia (FMD) is an orphan type of FMD, a non-atherosclerotic non-inflammatory arteriopathy predominantly among women aging from 20 to 60. The demographic, clinical features and therapeutic algorithm of iliac arterial FMD have not been precisely described. Patient Concerns: A 31-year-old Chinese male was referred for 3-month-ago onset hypertension, low serum potassium, and small-sized right kidney with normal renal artery under ultrasound examination. Spirolactone was poorly effective in this patient. Diagnosis: Contrast-enhanced computed tomographic angiography (CTA) and three-dimensional reconstruction of the whole aorta discovered an aneurysm from right common iliac artery (CIA) to the internal iliac artery, consistent with left CIA dissection and a remarkable right renal artery aneurysm before a stenosis, which was then confirmed through digital subtraction angiography. Intervention: Percutaneous transluminal angioplasty (PTA) of right renal artery was operated and a stent was deployed in left CIA. Outcome: This patient was normotensive, asymptomatic and free from recurrence without any antihypertensive agents at an 8-month follow-up. Conclusions: A total of 111 iliac arterial FMD cases (female, 84.7%; median age, 52±12.8 years) have been reported. Asymptomatic condition (49.5%) and claudication (40.5%) consist the majority of clinical presentations. Bruit (64.9%) and pulse deficits (39.4%) are the most popular signs. External iliac artery involved is approximate threefold of common and internal iliac arteries, usually accompanied with renal artery (71.2%, presenting hypertension) or carotid artery involvement (50.5%). A system screening among iliac or renal arterial FMD patients is therefore suggested with CTA from neck to pelvis and MRA in head. Dissection accounts for 15.3% cases, usually presenting ischemia symptoms with an inclination to young males. Conservative medication is efficient among 61.3% patients and PTA was operated in 15 patients with satisfactory outcomes in 86.7%. Stenting is an optimal recommendation of iliac artery FMD with progressive dissection. PTA is the first choice of short-duration renovascular hypertension due to FMD especially in young patient.

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