Spontaneous Isolated Dissection of Iliac Artery Treated with Endovascular Repair: A Case Report

Abstract

Spontaneous isolated dissection of the iliac artery (SID-IA) is a rare pathologic condition. The predisposing factors and best treatment strategies are still being debated. We present the case of a 59-year-old male with acute right lower limb ischemia characterized by the sudden occurrence of rest pain, hypoesthesia, and paresis. Angiography showed SID-IA extending down to the femoral bifurcation. The patient had no risk factors for SID-IA; however, he survived an electrocution and had arterial hypertension at admission. Endovascular revascularization was successfully performed, with complete restoration of limb blood flow and remission of symptoms. Follow-up ultrasonography at 1 year confirmed stent patency and absence of clinical symptoms. Endovascular stenting is a good therapeutic option for symptomatic SID-IA without rupture.

Keywords: Accidental electrocution; Dissection; Endovascular technique; Hypertension; Iliac artery.

Fig. 1

Computed tomographic reconstruction showed dissection from the origin of the right common iliac artery to the femoral bifurcation. Red arrows indicate the entry sites.

Fig. 2

Cross-sectional images of the computed tomography scan showed the dissection of the right external iliac artery.

Fig. 3

Diagnostic angiography before the endovascular revascularization confirmed the right iliofemoral dissection.

Fig. 4

Completion angiography after stenting showed fully restored blood flow into the right iliofemoral axis. A hydrophilic guidewire was used to cross the true lumen of the dissected common iliac artery into the superficial femoral artery, and 2 stents were successfully deployed.