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Endovascular Repair of an Infected Ruptured Isolated Iliac
Artery Aneurysm Combined With Congenital Lymphedema
( Report of a Case)
Fuxian Zhang,Huan Zhang
Department of Vascular Surgery, Beijing Shijitan Hospital,
Capital Medical University,Beijing, China
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Case report
• A 46-yrs-old man underwent extracorporeal shock wave lithotripsy
(ESWL) for left renal calculus in other hospital.
• The patient presented with a mass in the left lower quadrant and
abdominal pain 5 days later of ESWL .
• Past medical history : congenital lymphedema of the left lower limb for
40 years
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Case report
• However, the patient did not seek any treatment for 60 days until he
was admitted to our hospital for high fever
• Physical examination showed a big nonpulsatile mass about 20 ×
10 cm with tenderness at the left lower quadrant.
• Laboratory investigations revealed white cell count of 12.3 × 109/L
and hemoglobin of 12.5 g/L on admission.
• Abdominal sonography revealed a massive retroperitoneal
hematoma and a large aneurysm at the left common iliac artery
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CTA
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Diagnosis and initial treatment
The initial diagnosis was a ruptured left common iliac
artery aneurysm with infected hematoma.
Percutaneous drainage of the hematoma was done to
control infection.
Enterococcus faecium was isolated from the hematoma
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•Patient was treated with antibiotics
•The fever was well controlled and leucocyte count fell
to normal, and hemoculture showed negative result
after 2 weeks’ drainage and anti-infection therapy.
Diagnosis and initial treatment
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• We selected 2 iliac graft limbs
(TFLE 22 mm × 88 mm and 18
mm × 88mm; William Cook
Europe)
J Vasc Interv Radiol 2009; 20:403– 406
• Used the technique for reversing
the proximal and distal
orientations of a flared bell-bottom
Zenith iliac limb to avoid endoleak
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• But angiography showed a little migration from the aortoiliac bifurcation
to distal of the left common iliac artery and significant endoleak
• An additional inverted Zenith device leg of iliac graft limb (TFLE 22 mm
× 71 mm) was deployed to achieve complete exclusion of the left
common iliac artery aneurysms.
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15th post operation
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6m post op
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One year post op
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Conclusion
• This case illustrates the successful treatment and
endovascular repair of an infected IIAAs combined with
congenital lymphedema of the left lower limb.
• The technique of Zenith leg stent-graft inversion is a
useful approach in cases of IIAAs even in complicated
cases.
• Further studies are needed
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Endovascular Repair of an Infected Ruptured Isolated Iliac
Artery Aneurysm Combined With Congenital Lymphedema
( Report of a Case)
Fuxian Zhang,Huan Zhang
Department of Vascular Surgery, Beijing Shijitan Hospital,
Capital Medical University,Beijing, China