Iliac arteriovenous fistula -endovascular stent-graft treatment followed by aneurysm sac embolization due to persistent endoleak type 2

Abstract

The presented case is a 66-year old, previously healthy male patient with a 60 mm iliac artery aneurysm and arteriovenous fistula ( AVF) between the left common iliac artery and vein. The patient was treated successfully endovascular with a stent graft followed by embolization of the persistent endoleak type 2. The patient experienced sudden left-sided lower abdominal pain and left leg swelling with a 3-day onset. Upon admission, the patient displayed normal vital signs. There was no limb ischemia and echocardiography was within the normal limit. The abdomen was soft and without pain on examination or pulsatile mass. The bifurcated EVAR stent graft was deployed infrarenal. The left internal iliac artery was embolized with micro coils. There was an immediate effect on the left limb, with dramatically decreased swelling. CT showed persistent fistulation to the common iliac vein and type 2 endoleak on a three-month follow-up control. The left femoral vein was approached, and aneurysm sac embolization was performed with detachable micro coils. Three months follow-up CT control demonstrated shrinkage of the aneurysm sac with a maximal diameter of 46 mm and no flow through the AVF.