Objectives To present successful combined endovascular repair of a huge spontaneous pseudoaneurysm located at the bifurcation of left common iliac artery in a patient troubled with fever of unknown origin solely.
Methods A 79-year-old male patient complained of repeated episodes of fever for about 5 weeks, of which antibiotics were given for 4 weeks for suspected sepsis. Spontaneous formation of an 81.9 × 61.6-mm pseudoaneurysm, originating from left iliac arteries and covering the bifurcation of left common iliac artery and proximal ends of both internal and external iliac arteries, was confirmed by computed tomographic angiography accidentally. Then a combination of endovascular repair with coils embolisation and stent-graft exclusion were successfully performed. The patient underwent an uneventful recovery.
Results Spontaneous pseudoaneurysm with atypical manifestations shouldn’t been ignored. Combined transcatheter managements might be an alternative choice to deal with complex pseudoaneurysms effectively and safely.
Conclusions In this case, the PA is a complex lesion as some episodes of a giant size, a wide neck and location of vessel bifurcation existed simultaneously. Considering those situations, we tend to opt for a combined endovascular managements sequentially. Embolisation internal artery with coils ensured that insures no recurrence of blood flow into the PA and then occlusion he ruptured PA and support the vessel that supplied blood to the lower extremity with a self-expandable covered stent-graft were performed successfully. The result of 1.5-year follow-up confirmed the combined treatment effective and safe.
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