# Endovascular repair of a hypogastric artery aneurysm with arteriovenous fistula in a patient with iliac vein thrombosis: A case report

## TL;DR

A rare case of a concurrent aneurysm and arteriovenous fistula in Iran was successfully treated using endovascular techniques.

## Contribution

First reported case in Iran of a concurrent internal iliac artery aneurysm and ilio-iliac arteriovenous fistula.

## Key findings

- Endovascular techniques like stent grafting and coil embolization effectively treated the aneurysm and AVF.
- CT angiography was crucial for accurate diagnosis in this atypical case.
- The patient experienced significant symptom relief after treatment.

## Abstract

Abdominal aneurysms, often involving the iliac arteries, pose serious risks if untreated. Iliac arteriovenous fistulas (AVFs) are rare, typically secondary to trauma or deep vein thrombosis, with unclear mechanisms. They may present with high-output heart failure, abdominal bruits, and venous congestion. Computed tomography angiography (CTA) is essential for diagnosing aortoiliac aneurysms and fistulas. Endovascular repair, including recanalization and stenting, is the preferred approach, emphasizing precise preoperative planning and intraoperative execution to restore hemodynamics and minimize complications.

A 65-year-old male with chronic venous insufficiency for 12 years presented with acute left leg pain, severe edema, and inflammation. Despite persistent symptoms, no prior work-up had been performed, and he had only used compression stockings. Doppler sonography revealed acute thrombosis of the left common and external iliac veins with a pelvic vascular mass. He was admitted and started on anticoagulation. CTA identified a 90-mm left internal iliac artery aneurysm, an iliac AVF, and left common iliac vein occlusion. Endovascular repair was planned with initial coil embolization, but due to the aneurysm's size, a stent graft was deployed from the left common iliac to the proximal external iliac artery, successfully excluding the aneurysm. The patient recovered uneventfully with significant symptom relief.

The coexistence of an aneurysm and an AVF has not been reported in Iran. Ilio-iliac AVF, a rare complication of aortoiliac aneurysms, requires thorough evaluation.

CT angiography is crucial, especially in atypical cases. Selecting the optimal endovascular approach remains a challenge, requiring individualized management.

•First reported case in Iran of a concurrent internal iliac artery aneurysm and ilio-iliac arteriovenous fistula (AVF)•Successful use of endovascular techniques (stent grafting and coil embolization) to treat the aneurysm and AVF•Accurate diagnosis using computed tomography angiography (CTA) as the gold standard for atypical cases•Significant improvement in patient symptoms post-treatment, including reduced swelling and restored blood flow•Emphasis on precise preoperative planning and individualized management to minimize complications

First reported case in Iran of a concurrent internal iliac artery aneurysm and ilio-iliac arteriovenous fistula (AVF)

Successful use of endovascular techniques (stent grafting and coil embolization) to treat the aneurysm and AVF

Accurate diagnosis using computed tomography angiography (CTA) as the gold standard for atypical cases

Significant improvement in patient symptoms post-treatment, including reduced swelling and restored blood flow

Emphasis on precise preoperative planning and individualized management to minimize complications