Isolated internal iliac artery aneurysm causing rectal necrosis due to compression early after endovascular repair: A case report

Toru Imagami; Satoru Takayama; Taku Hattori; Ryohei Matsui; Hisanori Kani; Akimitsu Tanaka; Satoshi Kurokawa

doi:10.1016/j.ijscr.2019.07.016

Isolated internal iliac artery aneurysm causing rectal necrosis due to compression early after endovascular repair: A case report

Int J Surg Case Rep. 2019:61:73-76. doi: 10.1016/j.ijscr.2019.07.016. Epub 2019 Jul 19.

Authors

Toru Imagami¹, Satoru Takayama², Taku Hattori², Ryohei Matsui², Hisanori Kani², Akimitsu Tanaka³, Satoshi Kurokawa⁴

Affiliations

¹ Department of surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan. Electronic address: i-toru@nagoya.tokushukai.or.jp.
² Department of surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan.
³ Department of Cardiology of Heart Center, Nagoya Tokushukai General Hospital, Kasugai City, Japan.
⁴ Department of urology, Nagoya Tokushukai General Hospital, Kasugai City, Japan.

Abstract

Introduction: Recently, endovascular repair has become the first-line treatment for internal iliac artery aneurysm (IIAA). However, rectal necrosis due to the compression of the residual IIAA early after endovascular repair is rare.

Presentation of case: We present a rare case of a huge, isolated left IIAA that severely compressed the rectum and ureter. The patient underwent emergency endovascular repair; however, rectal necrosis occurred 10 days later because the repair failed to shrink the size of the aneurismal sac.

Discussion: We hypothesize that the compression of the residual IIAA caused rectal necrosis. During open surgery, endovascular repair disrupted blood flow within the IIAA, which probably allowed for aneurysm dissection and residual hematoma removal.

Conclusion: Endovascular repair alone could not immediately release compression on the surrounding organs; however, open surgical removal of aneurysms after successful endovascular repair may be a useful option for IIAAs with compression of surrounding organs.

Keywords: Endovascular repair; Isolated internal iliac artery aneurysm; Rectal necrosis; Residual aneurysm.