A Spontaneous Dissecting Abdominal Aneurysm Originating from the Iliac Artery
Article Outline
Abstract
Aortic dissection often involves the thoracic and abdominal aorta, whereas isolated abdominal aortic dissection is rare. Few cases of abdominal aortic dissection caused by iliac arterial dissection have been reported. Herein, we report a case of spontaneous isolated abdominal dissection in which both the entry and exit sites were in the iliac arteries. The patient was treated successfully using the endovascular aneurysm repair procedure.
Keywords: Aortic dissection, Iliac artery, Endovascular aneurysm repair
Introduction
Aortic dissection occurs when layers of the aortic wall separate as a result of the extraluminal entry of blood through an intimal tear. Aortic dissection commonly involves the thoracic or abdominal aorta. Few cases of iliac arterial dissection involving the abdominal aorta have been reported.1 Herein, we report a case of spontaneous isolated abdominal aortic dissection in which both the entry and exit sites were within the iliac artery segment.
Case Report
The patient was a 59-year-old man who presented with a chief complaint of recurrent abdominal pain lasting 1 year in duration. The pain increased over the previous 4 months and was concentrated in the left lower quadrant near the middle abdomen. The patient found a pulsatile mass at the same location. He described the pain as dull and not affected by movement or position. He denied any other symptoms. The patient’s medical history was negative for collagen vascular disorders such as Ehlers–Danlos syndrome or Marfan’s syndrome, and he denied previous significant trauma. His family history also was negative for collagen vascular disorders. The patient reported no use of cigarettes or alcohol. His vital signs were within the normal range. A physical examination was normal; however, a pulsatile vertical mass of approximately 5 cm × 6 cm in size was palpable above the umbilical region. Laboratory results were within the normal range. A computed tomography scan of the abdominal aorta showed a bilateral dissection of the iliac arteries and abdominal aorta (Fig. 1). The dissection did not communicate with the abdominal aorta but did perfuse the inferior mesenteric artery.
Figure 1
Abdominal computed tomography scan. Left panel. Arrow 1 points to the false lumen, without a channel between the false lumen and the abdominal aorta. Arrow 2 shows the entry site of the false lumen. Right panel. The entry and exit sites of the false lumen, which extended in a retrograde manner to the abdominal aorta (AA) and involved the inferior mesenteric artery (SMA). Arrow 1 points to the entry site of the false lumen. Arrow 2 shows the exit site within iliac artery (IA).
After careful preoperative evaluation and preparation, the patient was treated with endovascular therapy. A preoperative digital subtraction angiography (DSA) showed that the direction of the blood flow in the dissection was from the right iliac artery to the left one. Two groin incisions were made under general anaesthesia to expose the common femoral arteries. A Luderquiest super stiff guide wire (Cook, USA) was used to insert the main body of the stent graft (Microport, China) into the abdominal aorta and the right common iliac artery. The contralateral cuff was released to the main body of the stent graft through the predilated left common iliac artery. Three months after discharge, a computed tomographic angiography revealed that the false lumen was excluded completely, without any endoleak (Fig. 2). The patient has not had any discomfort since the procedure was completed.
Figure 2
A follow-up computed tomography scan image taken 3 months after the operation shows that the dissection was closed completely by the stent graft, without any endovascular leakage.
Discussion
Although an isolated abdominal aortic dissection may be more approximate in this case, an entry site at the false lumen is quite uncommon from other reports.2, 3, 4 As far as we are aware, it is extremely rare to find an abdominal aortic dissection caused by the intimal flap and originating within the iliac artery.5 Our case findings suggest that there is uncertainty and variety in the origination of an abdominal aortic dissection.
In the case described here, the patient experienced chronic, dull abdominal pain, the dissection ran from iliac artery to abdominal aorta and the patient had no risk factors. We have no explanation for the dissection, except that atherosclerosis plaque was found in the right iliac artery and may have contributed to the dissection (Fig. 1). The highest incidence of aortic dissection occurs among men aged 50–70 years. A history of hypertension and bicuspid aortic valve are the most common associated conditions. Less commonly associated conditions include Marfan’s syndrome and other connective tissue disorders; a family history of dissection; coarctation of the aorta; pregnancy, especially in the third trimester; blunt trauma; iatrogenic causes such as catheterisation or insertion of an intra-aortic balloon pump; syphilis; affiliated abdominal aorta aneurysm; and spontaneous condition.6
Conflict of Interest/Funding
None.
References
- . Aortic dissection. N Engl J Med. 1987;22:1060–1067
- Isolated dissection of the abdominal aorta: clinical presentation and therapeutic options. J Vasc Surg. 2002;36:205–210
- . Aortic dissection with the entrance tear in abdominal aorta. Am Heart J. 1991;121:1834–1835
- Spontaneous acute abdominal aortic dissection. Ann Vasc Surg. 1998;12:373–378
- . Endovascular repair of a ruptured abdominal aortic aneurysm in a patient with bilateral iliac dissections. Ann Vasc Surg. 2011 Oct;25(7):981
- Treatment of infrarenal abdominal aortic dissection concomitant with an aneurysm. Chin Med J. 2007;120:169–170
PII: S1533-3167(11)00044-6
doi:10.1016/j.ejvsextra.2011.12.003
© 2012 European Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
Refers to article:
- A Spontaneous Dissecting Abdominal Aneurysm Originating from the Iliac Artery Corrected Proof, 27 January 2012
