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Abstract: In this case, an iliac artery aneurysm with a tumor diameter of approximately 3 cm was detected during a routine physical examination and the patient was admitted to the hospital. In order to avoid rupture of the iliac artery aneurysm, the patient was advised to be admitted for further examination. Subsequently, the diagnosis of bilateral internal iliac artery aneurysm was clearly made by aortic CTA examination, and after discussion with the patient and his family, it was decided to perform surgical treatment, which was iliac artery overlying stent implantation and embolization of internal iliac artery aneurysm.
Basic information】Male, 69 years old
Disease Type】Bilateral internal iliac aneurysm
Hospital】Xing’an League People’s Hospital of Inner Mongolia
Time of consultation】April 2022
Treatment plan】Surgical treatment (iliac artery overlay stenting + internal iliac artery embolization)
Treatment period】5 days of hospitalization, 14 days of incision removal after surgery, 3 months of re-examination
Results】The iliac artery aneurysm disappeared after surgery, and the patient was discharged from the hospital.
I. Initial consultation
One day in April 2022, a hale and hearty patient came into the clinic and took out a CT report of the abdomen, which showed a possible iliac artery aneurysm with a diameter of about 3 cm, and then suggested the patient to have further CTA examination to clarify the diagnosis, and explained to the patient that clinically there is a certain risk of rupture of iliac artery aneurysm over 3 cm, and once the aneurysm ruptures, it may cause serious blood loss and even hemorrhagic shock. The patient was advised to be hospitalized for further examination and treatment. The patient was very cooperative and was successfully hospitalized.
II. Treatment process
After hospitalization, blood tests, cardiac ultrasound, electrocardiogram and aortic CTA were completed. The aortic CTA showed bilateral internal iliac artery aneurysms with a diameter of about 31 mm on the left side and 17 mm on the right side, and the patient’s family was informed of the seriousness of the disease and the surgical plan, which was to perform left iliac artery overlapping stent implantation + internal iliac artery embolization. The patient’s family was informed in detail of the risks and possible complications of the operation, and the family’s consent was obtained before emergency surgery was performed. A left inguinal incision was made, and the left common iliac artery and internal iliac artery aneurysm were seen on imaging. The internal iliac artery aneurysm was first embolized with a controlled spring coil, and then an iliac artery overlay stent was implanted.
III. Treatment effect
The patient continued to be given cardiac monitoring and continuous oxygenation after the operation, and blood pressure and heart rate were strictly controlled, and the left lower extremity was bed-bound for 24 hours. The patient recovered well after surgery, and there were no significant abnormalities in blood routine and blood biochemistry on postoperative reexamination, good pulsation of bilateral femoral arteries, good healing of the left inguinal incision, and no exudation. Three months after the operation, the patient came to the hospital to review the aortic CTA and observe the situation of internal iliac aneurysm, which showed that after active and effective treatment, the iliac aneurysm disappeared and recovered well.
IV. Precautions
We are truly happy that this patient was cured after following the medical advice and promptly seeking medical treatment for surgery. Although the patient gradually recovered after active treatment, he should also pay attention to his surgical site after he goes home initially and seek medical attention promptly if abnormal symptoms such as redness, swelling, and oozing appear. In addition, follow up regularly according to the doctor’s prescribed schedule. In life, the diet should be light and nutritious to help promote local wound healing, and avoid spicy and stimulating foods and raw and cold foods. Pay attention to rest and avoid staying up late so as not to cause recurrence or aggravation of disease symptoms.
V. Personal insight
Iliac artery aneurysms are not common in clinical practice, and because there are usually no specific symptoms, they are very easy to be missed and misdiagnosed. However, it should be noted that if the diameter of iliac aneurysm exceeds 3 cm, the risk of bleeding will increase significantly, and timely surgery is needed. Since the cause of iliac aneurysm is mostly related to high blood pressure, patients must strictly control their blood pressure to maintain it around 120/80 mmHg to slow down the development of aneurysm and reduce the risk of aneurysm rupture. For patients with other underlying diseases, it is important to have regular medical checkups every year, and after problems are found, as in this patient, regular follow-ups to observe changes in the condition and treat the condition accordingly can effectively prevent the development of the disease.