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Abstract: Iliac aneurysm is an infection and damage to the vessel wall of the iliac artery due to infection or atherosclerosis. Hypertension and diabetes mellitus are high-risk factors, and blood pressure and blood sugar must be strictly controlled and medication taken on time in general. The patient in this case was sent to the emergency room because of a history of hypertension, poor blood pressure control, and unexplained lower abdominal pain. After screening, a ruptured iliac artery aneurysm was found to bleed, and a green channel was opened, and the abdominal pain disappeared after emergency surgery, and the bilateral femoral arteries were pulsating well.
Basic information】Male, 47 years old
Disease Type】Left common iliac artery end, left internal iliac artery aneurysm, ruptured iliac artery bleeding
Hospital】Xing’an Meng People’s Hospital of Inner Mongolia
Date of consultation】January 2022
Treatment plan】Iliac artery overlying stenting + internal iliac artery embolization
Treatment Period】7 days of hospitalization and 3 months of outpatient follow-up
Results】Abdominal pain disappeared and bilateral femoral artery pulsation was good
I. Initial consultation
When we arrived at the emergency department, we saw the patient lying flat on the monitoring bed, pale and sweating, with his hand over the left lower abdomen and a painful expression. We learned that the patient had sudden onset of lower abdominal pain for 7 hours, had a past history of hypertension and diabetes mellitus, and poor blood pressure control, and that a CT of the abdomen was performed to consider a left iliac artery aneurysm, and an emergency CTA of the aorta showed a left common iliac artery end and a left internal iliac artery aneurysm. The results suggested that the patient’s condition was critical, and then the green channel was opened immediately and the patient was admitted to the ward.
II. Treatment process
After hospitalization, the patient was advised to stay absolutely in bed, given cardiac monitoring, continuous nasal catheter oxygenation, established intravenous access, and given rehydration fluids. The patient and his family were informed in detail of the risks and possible complications of the operation, and then the patient and his family agreed to perform the operation in an emergency. The procedure was performed by bilateral femoral artery puncture and imaging to clarify the iliac artery aneurysm, and the left common iliac artery and internal iliac artery aneurysm formation were seen. The internal iliac artery aneurysm was first embolized with a spring coil, and then an overlapping stent was implanted in the iliac artery, and the re-imaging showed that the internal iliac artery was well embolized, the stent was unobstructed, there was no overflow of contrast agent, and the iliac artery rupture was completely sealed.
III. Treatment effect
After the operation, the patient continued to receive cardiac monitoring, continuous oxygenation, keeping blood pressure, heart rate and blood glucose stable, using salt bags to pressurize the inguinal puncture sites bilaterally, and bed-braking the lower limbs for 24 hours. The patient’s abdominal pain disappeared after the operation, and there were no significant abnormalities in the blood routine and blood biochemistry on the reexamination, good pulsation of the bilateral femoral arteries, good healing of the puncture sites and no exudation. The patient was discharged from the hospital after 7 days of hospitalization, and was asked to come to the hospital for review 3 months after the operation, and CTA examination of the aorta was performed during the review.
IV. Notes
We are glad that the patient’s abdominal pain disappeared after surgical treatment and the condition was effectively controlled, but we suggest that the patient must closely observe the vital signs and the condition of the femoral artery puncture site after surgery to avoid stimulating the puncture site site and affecting the wound healing, and to review regularly to avoid postoperative complications. In addition, we should pay attention to maintain a good diet, mainly a light diet, avoid spicy and stimulating food, and follow the doctor’s instructions to take the medication on time and in accordance with the dosage, to avoid adding or subtracting medication on their own, which may cause other adverse effects.
V. Personal insight
As the incidence of hypertension and diabetes continues to increase in China, the incidence of vascular diseases such as iliac aneurysm is also increasing year by year. Therefore, for patients with underlying diseases, it is important to control the underlying diseases, make sure to have regular medical checkups every year, confirm the diagnosis after problems are found, and keep observing the changes of the disease, which can slow down the development of arterial diseases and also avoid serious situations that threaten life safety. Thankfully the patient’s condition was promptly brought under control through surgical treatment and no serious effects occurred.