Radiological Case

Mixed Connective Tissue Iliac Artery Aneurysm With Arteriovenous Fistula

Ryan Alexander, DO; Magda Rizer, DO; Robert Beasley, MD


Appl Radiol. 2016;45(5):38-39. 

In This Article


Isolated Iliac artery aneurysms are rare at < 1%.[1] Iliac artery aneurysms are seen in 10–20% of patients xdcki of abdominal aortic aneurysms.[2] The risk of rupture increases with aneurysm size and repair is recommended for aneurysms > 3 cm in diameter.[3] The presentation can be neurologic, genitourologic or gastrointestinal due to external compression. Abdominal pain is commonly present in symptomatic patients.

Conventional open surgery is appropriate for iliac artery aneurysms with compressive symptoms (neurologic or urologic).[4] Endovascular treatment cannot rapidly reduce aneurysm size. Aortoiliac EVAR is necessary if the common iliac artery origin is aneurysmal.[5] A proximal landing zone in aorta is required for graft seal and endoleak prevention. A common iliac artery aneurysm involving the iliac bifurcation requires graft extension into external iliac artery and concurrent embolization of internal iliac artery to prevent retrograde endoleak. Internal iliac artery coil embolization is performed prior to EVAR if the stent graft extends beyond the iliac bifurcation. Embolization prevents retrograde perfusion of the aneurysm sac following EVAR. There is a risk of buttock claudication and impotence with internal iliac artery embolization.[5]