An iliac arterial pseudoaneurysm diagnosed 40 years after suffering blunt trauma
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A chronic iliac arterial pseudoaneurysm caused by blunt trauma is very rare.
The patient had gunshot wound in the right thigh and blunt trauma 40 years earlier. An abdominal computed tomography revealed the presence of a right iliac arterial pseudoaneurysm, and we successfully treated the pseudoaneurysm by resection and in situ reconstruction with a bifurcated vascular prosthesis.
We herein present a rare case of a pseudoaneurysm of the right iliac artery diagnosed decades after blunt trauma.
KeywordsIliac arterial pseudoaneurysm Blunt trauma Chronic course
Pseudoaneurysms of the iliac artery are rare and are typically caused by infection, blunt trauma, or surgical procedures. The clinical signs and symptoms may appear within a few days of the event [1, 2, 3, 4]. We herein report a rare case of a pseudoaneurysm of the right iliac artery that was diagnosed decades after blunt trauma.
Pseudoaneurysms are often caused by infection or trauma. The number of iatrogenic cases has increased in recent years; however, the patient in our case had never undergone laparotomy or interventional procedures in the past. Furthermore, symptoms due to aneurysms are likely to appear early after trauma, and the rupture of a pseudoaneurysm represents a life threatening event [1, 2]. Few cases describe symptoms that appeared several years later [3, 4]. Our case had experienced traumatic events 40 years previously and had been aware of a pulsatile mass in his right groin for at least 20 years. Based on this evidence, it is assumed that the pseudoaneurysm of the iliac artery increased chronically. Although stent grafts have been reported to be effective for the treatment of pseudoaneurysms [5, 6], we decided to perform open surgery because the aneurysm extended to the common femoral artery, which meant that there was not enough landing zone for stent graft.
No pus or ascites was observed during surgery, and there were no findings of infection from cultures or resected specimens. Additionally, the iliac arterial aneurysms had penetrated each other and a pathological examination showed that the arterial wall structure had disappeared. We considered that the iliac arterial aneurysm had been caused by past trauma and that it might have been sealed by surrounding tissue in the retroperitoneal cavity and gradually increased in size. Thereafter, the pseudoaneurysm gradually expanded and became associated with local infection and inflammation from the common iliac artery to the common femoral artery. The possibility of infectious aneurysms was ruled out based on the lack of inflammatory findings and the negativity of the blood culture. Indeed, no apparent infections were observed intraoperatively or in an examination of the excised specimens. As a result, the postoperative course was uneventful, and no recurrence of any other infection or inflammation was observed during the 1-year follow-up period.
We herein presented a rare case of the successful treatment of a pseudoaneurysm of the right iliac artery that was diagnosed decades after blunt trauma. Since pseudoaneurysms may occur even a long period after a traumatic event, computed tomography should be used to make a precise diagnosis. Treatment should be administered soon after the diagnosis because of the high rate of mortality associated with the rupture of these lesions.
AG contributed to writing the manuscript. SM supervised the study. All authors read and approved the final manuscript.
The authors declare that they have no competing interests.
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