A Case of Isolated Right Common Iliac Aneurysm with Arteriovenous Fistula

(Department of Surgery, Mito Red Cross Hospital, Mito, Japan)

Norio Uchida Yasuko Miyaki
We report a case of arteriovenous fistula (AVF) secondary to spontaneous rupture of the right common iliac aneurysm into the right common iliac vein. In February 2003, an 81-year-old woman was admitted with dyspnea. Diuretics and digitalis were given under a provisional diagnosis of primary heart failure. Afterwards the heart failure turned out to be high output failure due to AVF. In June the patient complained of swelling of her right leg and was referred to our department. Ultrasonography to determine deep vein thrombosis of the right femoral vein revealed a dilatation of the left femoral vein, but there was no thrombosis. A pulse Doppler detected an arterial blood flow signal during early systolic pulse in the right femoral vein, confirming the suspicion of an AVF in abdominal cavity near this location. A pulsatile mass associated with bruit and thrill was palpable in the lower abdomen. Digital subtraction angiography showed a 50mm aneurysm of the right common iliac artery. Rapid visualization of the inferior vena cava and retrograde opacification of the right iliac vein indicated the presence of an AVF between the common iliac artery and vein. Operation was done by laparotomy on June 24, 2003. An occlusive balloon catheter was inserted from the right femoral vein and the balloon was dilated to patch the fistula before opening the aneurysm. After clamping the proximal and distal arteries the aneurysm was opened. By this maneuver there was no bleeding from the fistula. The AVF was closed from inside the aneurysm by 3 interrupted 4-0 monofilament sutures. The aneurysm was replaced with a prosthetic graft (Hemashield 8mm). The post-operative course was uneventful. The lower limb edema subsided and heart failure improved.
@Jpn. J. Cardiovasc. Surg. 34: 120-123 (2005)