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Abstract: An elderly male patient presented to our department with a right iliac artery aneurysm found on physical examination for 3 days. The patient indicated that he had a history of hypertension and coronary artery disease and had undergone coronary stenting. After admission, CTA of the aorta and both iliac arteries was completed and a right common iliac artery coarctation aneurysm and left common iliac artery and internal iliac artery aneurysm with appendage thrombosis were found. Considering the patient’s advanced age and underlying diseases, the patient was treated with endoluminal minimally invasive treatment, and after the operation, the patient recovered well with stable disease control.
Basic information】Male, 71 years old
Disease Type】Iliac aneurysm
Hospital】Liaoning Provincial People’s Hospital
Date of consultation】April 2021
Treatment plan】Surgical treatment (right common iliac artery aneurysm intracavitary repair surgery)
Treatment Period】7 days of inpatient treatment and outpatient follow up
Results】The patient recovered well, and a repeat CTA showed complete isolation of the aneurysm
I. Initial consultation
In April 2021, a 71-year-old male patient came to our department with a right iliac aneurysm found during a local physical examination. The patient had no obvious complaints of discomfort, no chest or abdominal pain, no cough or sputum, and no symptoms of lower limb ischemia. The patient had a history of hypertension, which was poorly controlled, and coronary artery disease, with coronary stenting in 2003 and 2014. On examination: abdomen was flat, no gastrointestinal pattern and peristaltic wave, about 3×4 cm pulsating mass could be palpated under the umbilicus to the right, vascular murmur could be heard, the patient could eat and sleep, stool was as usual, no significant weight loss.
II. Treatment history
After the patient was admitted to the hospital, CTA of the entire aorta was completed, and it was found that due to years of atherosclerosis, the overall vascular condition of the patient was poor, with the right common iliac artery, left common iliac artery, internal iliac artery aneurysm with wall thrombosis, right common iliac artery coarctation, right internal and external iliac artery from the true lumen, multiple atherosclerosis with varying degrees of luminal stenosis throughout the aorta, multiple wall thrombosis in the terminal abdominal aorta and both iliac arteries The patient’s condition was such that the patient had a penetrating ulcer.
In order to reduce the operation time and risk, the patient and his family were advised to prioritize the treatment of the right side of the coarctation aneurysm, to which the patient and his family agreed. Finally, the technique of minimally invasive endoluminal treatment, embolization of the right internal iliac artery, and endoluminal isolation of the iliac aneurysm was adopted, and the repair of the iliac aneurysm was successfully performed after a 2-hour operation.
III. Treatment results
The patient was hospitalized for 7 days, and the pulsating mass disappeared, while the patient had no symptoms such as abdominal distension and abdominal pain and normal urine and stool.
IV. Notes
I am glad that the patient’s condition has improved, but I would like to remind the patient to also pay attention to absolute smoking cessation after iliac aneurysm surgery, diet with low salt and low fat, more fresh fruits and vegetables, more high quality protein, and as little smoked, barbecued and fried food as possible; pay attention to more rest, avoid long time strain and staying up late, in addition, hypertension, coronary heart disease and other diseases should be monitored at all times and standardized treatment.
V. Personal insight
Iliac artery aneurysm is an abnormal dilatation of the iliac artery. If the maximum diameter is greater than 1.5 times the diameter of the normal iliac artery, surgical treatment is required. Most patients with iliac artery aneurysm combined with aneurysm of the terminal segment of the abdominal aorta need to be treated at the same time. This patient involved only the iliac artery and required embolization of the internal iliac artery to prevent the occurrence of endoleaks after endoluminal treatment.
Once the iliac aneurysm is diagnosed, it is still recommended to visit a specialized vascular surgery department for early and aggressive management.