Arteriojejunal Fistula Presenting with Recurrent Obscure GI Hemorrhage in a Patient with a Failed Pancreas Allograft

We present a case of a patient with a failed pancreaticoduodenal allograft with exocrine enteric-drainage who developed catastrophic gastrointestinal (GI) hemorrhage. Over the course of a week, she presented with recurrent GI bleeds of obscure etiology. Multiple esophago-gastro-duodenoscopic (EGD) and colonoscopic evaluations failed to reveal the source of the hemorrhage. A capsule endoscopy and a technetium-labeled red blood cells (RBC) imaging study were similarly unrevealing for source of bleeding. She subsequently developed hemorrhagic shock requiring emergent superior mesenteric arteriography. Run off images revealed an external iliac artery aneurysm with fistulization into the jejunum. Coiled embolization was attempted but abandoned because of hemodynamic instability. Deployment of a covered endovascular stent into the right external iliac artery over the fistula site resulted in immediate hemodynamic stabilization. A high index of suspicion for arterioenteric fistulae is needed for diagnosis of this uncommon but eminently treatable form of GI hemorrhage in this patient population.

Download Full-text

Giant External Iliac Artery Aneurysm

Annals of Vascular Surgery ◽

10.1016/j.avsg.2018.11.012 ◽

2019 ◽

Vol 58 ◽

pp. 386.e1-386.e3

Author(s):

Ahmad Syed Hussain ◽

Abdulhameed Aziz

Keyword(s):

Iliac Artery ◽

Artery Aneurysm ◽

External Iliac Artery ◽

Iliac Artery Aneurysm

Download Full-text

Ureteral Obstruction Secondary to Inflammatory Isolated External Iliac Artery Aneurysm

EJVES Extra ◽

10.1053/ejvx.2000.0001 ◽

2001 ◽

Vol 1 (1) ◽

pp. 1-2

Author(s):

L. Isõkay ◽

B. Kocak ◽

M. Bayazit

Keyword(s):

Iliac Artery ◽

Ureteral Obstruction ◽

Artery Aneurysm ◽

External Iliac Artery ◽

Iliac Artery Aneurysm

Download Full-text

A Unique Indication for the Altura Endograft to Repair Bilateral Common Iliac Artery Aneurysms Associated with a Short–Infrarenal Aorta

Aorta ◽

10.1055/s-0040-1702142 ◽

2020 ◽

Vol 08 (02) ◽

pp. 041-045

Author(s):

Stavros K. Kakkos ◽

Chrysanthi P. Papageorgopoulou ◽

Konstantinos Katsanos ◽

Peter Zampakis ◽

Athina Siampalioti ◽

...

Keyword(s):

Iliac Artery ◽

Common Iliac Artery ◽

Artery Aneurysm ◽

Infrarenal Aorta ◽

Iliac Artery Aneurysm ◽

Internal Iliac ◽

The Right ◽

Stage Renal Disease ◽

End Stage ◽

Tomographic Angiography

AbstractA 71-year-old man with end-stage renal disease on hemodialysis presented with bilateral common iliac artery aneurysms diagnosed during the workup of his chronic kidney disease. On computed tomography angiography, common iliac artery aneurysm diameters measured 6.1 cm on the right side and 3.1 cm on the left side. The infrarenal aorta also had a small 3.2-cm aneurysm, but the length from the lowest left renal to the aortic bifurcation was only 6.7 cm, precluding use of most bifurcated endografts. Following an uneventful staged preoperative internal iliac artery embolization, a two-piece D-shaped Altura endograft for the aorta, with bilateral iliac components, landing at the level of the external iliac arteries was successfully performed. Postoperative course was uneventful with no endoleak or endograft migration on computerized tomographic angiography 45 days later, although billowing mimicking an endoleak was evident and will be closely followed.

Download Full-text

Fornix Rupture in Duplex Kidney due to Internal Iliac Artery Aneurysm

Case Reports in Urology ◽

10.1155/2016/5042456 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Phitsanu Mahawong ◽

Tanop Srisuwan ◽

Kittipan Rerkasem

Keyword(s):

Iliac Artery ◽

Internal Iliac Artery ◽

Artery Aneurysm ◽

Abdominal Ultrasound ◽

Selective Embolization ◽

Iliac Artery Aneurysm ◽

Duplex Kidney ◽

Internal Iliac Artery Aneurysm ◽

Internal Iliac ◽

The Right

A 70-year-old man presented with severe pain on the right side of the abdomen for 7 days. An abdominal CT angiographic scan showed an impending rupture of a large right internal iliac artery aneurysm which compressed to a right ureter causing hydroureteronephrosis. Fornix rupture of a right duplex kidney was also detected. Selective embolization of right gluteal arteries and then ligation of the right internal iliac artery and right ureterotomy with double J stenting were performed. At the 4-month follow-up appointment, an abdominal ultrasound demonstrated a decrease in the size of the aneurysm and no hydroureteronephrosis after the removal of double J stent.

Download Full-text

Hybrid Open Endovascular Repair of Para-Anastomotic Common Iliac Artery Aneurysm in the Presence of Bilateral External Iliac Artery Occlusions

Annals of Vascular Surgery ◽

10.1016/j.avsg.2008.03.001 ◽

2009 ◽

Vol 23 (3) ◽

pp. 410.e13-410.e16

Author(s):

Robert S.M. Davies ◽

John M. Henderson ◽

Mark J. Scriven ◽

Donald J. Adam

Keyword(s):

Iliac Artery ◽

Endovascular Repair ◽

Common Iliac Artery ◽

Artery Aneurysm ◽

External Iliac Artery ◽

Iliac Artery Aneurysm ◽

Common Iliac Artery Aneurysm

Download Full-text

BILATERAL EXTERNAL ILIAC ARTERY ANEURYSM IN A YOUNG PATIENT

Journal of Vascular Surgery Cases and Innovative Techniques ◽

10.1016/j.jvscit.2021.12.006 ◽

2022 ◽

Author(s):

Caroline Mieko Tanaka ◽

Marcelo Fernando Matielo ◽

Edson Takamitsu Nakamura ◽

Sergio Roberto Tiossi

Keyword(s):

Young Patient ◽

Iliac Artery ◽

Artery Aneurysm ◽

External Iliac Artery ◽

Iliac Artery Aneurysm

Download Full-text

Double D Technique: An Innovative Modified Bifurcated Stent Graft Deployment Strategy for an Isolated Common Iliac Artery Aneurysm With a Challenging Renal Artery Anatomy

Vascular and Endovascular Surgery ◽

10.1177/1538574419862671 ◽

2019 ◽

Vol 53 (7) ◽

pp. 613-616 ◽

Cited By ~ 1

Author(s):

Yusuke Date ◽

Tamaki Takano ◽

Taishi Fujii ◽

Takamitsu Terasaki ◽

Masayuk Sakaguchi

Keyword(s):

Renal Artery ◽

Iliac Artery ◽

Common Iliac Artery ◽

Endovascular Aneurysm Repair ◽

Artery Aneurysm ◽

Aortic Bifurcation ◽

Iliac Artery Aneurysm ◽

Common Iliac Artery Aneurysm ◽

The Right ◽

Aneurysm Repair

Purpose: Endovascular aneurysm repair (EVAR) for an isolated common iliac artery aneurysm (iCIAA) sometimes requires a bifurcated stent graft (SG). In EVAR, it is essential to preserve the renal artery (RA). However, this is challenging in cases of anatomical variation. The double D technique (DDT) can be used in anatomically inadequate cases with a commercially approved bifurcated SG. Here, we report the repair of iCIAA in the presence of a challenging RA anatomy, through EVAR using the DDT. Case Report: An 84-year-old woman was diagnosed with a maximal 35-mm diameter left iCIAA and a nonaneurysmal aorta by computed tomography (CT), which also showed that the right RA arose 50-mm above the aortic bifurcation. The DDT was chosen because commercially approved bifurcated SGs typically require a distance of >70 mm from the proximal position to the aortic bifurcation. Postoperative CT showed excellent results with no endoleaks or SG kinking and occlusion, as well as preservation of robust blood flow to the right RA. Conclusion: Endovascular aneurysm repair using the DDT can be an alternative option for treatment of iCIAA with a challenging RA anatomy.

Download Full-text