Endovascular Repair of a Common Iliac Pseudoaneurysm and Aortic Ectasia in a Patient with Horseshoe Kidney and Pancreatitis: A Case Report

Abstract

We present the first case of 45 year-old male with an incidental non-symptomatic right common iliac artery pseudoaneurysm with concomitant aortic ectasia in the setting of severe alcoholic pancreatitis and a horseshoe kidney diagnosed by CT and MRA. Such findings would have posed significant difficulty during an open approach precluding safe surgical repair. Therefore, an exclusion endovascular repair of the pseudoaneurysm was employed using a unibody bifurcated endovascular aortic stent-graft to good results. Although not without their complications, endovascular stent-grafts may be life saving to patients who are not candidates for conventional surgical repair. We describe the diagnosis alongside our technique of endovascular repair.

The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm

“…[502][503][504] If the main renal arteries are located proximal to the aneurysm, EVAR can be safely performed. 505,506 Small accessory renal arteries may be covered by EVAR. 507,508 In cases with anomalous blood supply, OSR (preferably through a retroperitoneal approach), hybrid repair, or fenestrated or branched EVAR may be considered.…”

Same Clinical Reality of Spontaneous Rupture of the Common Iliac Artery with Pseudoaneurysm Formation—Comparison of Two Therapeutical Solutions, Endovascular Stent-Graft and Open Surgical Correction, for Two Cases and Review of the Literature

“…The endovascular method of treating iliac artery pseudoaneurysms began with using endovascular stents alone [ 36 ], arriving now to the implantation of grafted stents [ 37 ], or using coils in combination with stents [ 38 ]. These approaches eliminated the need, in select cases, for conventional surgical methods, such as patch angioplasty, lateral suturing for narrow-necked pseudoaneurysms, or graft interposition for those with a wider neck, which are procedures accompanied by multiple disadvantages, such as a long hospitalization time, the requirement of general anesthesia, and the possibility for impaired wound healing, and are associated with a higher morbidity and mortality rate [ 39 ]. The sturdiness of iliac pseudoaneurysm endovascular repair is still debatable, with a lack of long-term reported outcomes.…”

“…In certain cases (such as ours), the ePTFE patch can be less useful, as it can be more rigid and, whilst using a 4-0 Prolene suture, the needle holes made can increase the risk of bleeding. [ 38 , 39 ]…”

Efficacy of Unibody Bifurcated Endovascular Stent-Graft Repair in the Treatment of Abdominal Aortic Aneurysm

“…Abdullah et al revealed that although not without complications, endovascular stent-grafts might be lifesaving to patients who were not candidates for conventional surgical repair. 12 Albertini et al found endovascular repair using the bifurcated powerlink stent-graft as safe and effective, and unibody design seemed to confer advantages in terms of durability. 13 Further analysis showed that the incidence of pulmonary complications and electrolyte imbalance in Group B patients was lower than that in Group A during the perioperative period.…”