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Case Reports
. 2023 Apr 7:22:e20220119.
doi: 10.1590/1677-5449.202201192. eCollection 2023.

Isolated external iliac artery aneurysm: a rare case presentation of IgG4-related disease

Naveen Maheshwari  1 , Venkata Vineeth Vaddavalli  1 , Kishore Abuji  1 , Ajay Savlania  1 , Ritambhra Nada  1
Affiliations
Case Reports

Isolated external iliac artery aneurysm: a rare case presentation of IgG4-related disease

Naveen Maheshwari et al. J Vasc Bras. .

Abstract
in English, Portuguese

Isolated external iliac artery aneurysm is a rare occurrence. These aneurysms have varied presentations depending on size and proximity. Both open surgical and endovascular modalities can be used for treatment depending upon presentation, aneurysmal anatomy, and patient condition. Preservation of at least one internal iliac artery is important to prevent post-repair hypogastric ischemia. There are no previous reports of IgG4-related disease (IgG4-RD) as etiology of these aneurysms. A 32-year-old male patient presented with a left lower abdominal lump and was found to have a left external iliac artery aneurysm on computed tomography angiography. The patient underwent iliofemoral bypass with an 8 mm polyester graft. Histopathological examination of the aneurysm wall suggested IgG4-RD. The patient fulfilled the 2020 Revised Comprehensive Diagnostic Criteria for IgG4-RD. An 18-Fluorodeoxyglucose-Positron Emission Tomography scan performed in the postoperative period showed no active disease, hence medical therapy was not instituted. The patient is doing well at 1 year.

O aneurisma isolado da artéria ilíaca externa é uma ocorrência rara. Esses aneurismas têm apresentações variadas, dependendo do tamanho e da proximidade. Ambas as modalidades cirúrgicas aberta e endovascular podem ser usadas para o tratamento, dependendo da apresentação, anatomia do aneurisma e condição do paciente. A preservação de pelo menos uma artéria ilíaca interna é importante para prevenir isquemia hipogástrica pós-reparação. A doença relacionada à imunoglobulina G4 (IgG4-RD) nunca havia sido encontrada como etiologia desse aneurisma. Um paciente do sexo masculino de 32 anos que apresentava um nódulo no abdome inferior esquerdo foi diagnosticado com aneurisma da artéria ilíaca externa esquerda na angiotomografia computadorizada. O paciente foi submetido a bypass iliofemoral com enxerto de poliéster de 8 mm. O exame histopatológico da parede do aneurisma era indicativo de IgG4-RD. O paciente cumpriu os Critérios Abrangentes Revisados ​​para IgG4-RD de 2020. A tomografia por emissão de pósitrons com 18-fluorodesoxiglicose no pós-operatório não evidenciou doença ativa, não sendo instituída terapia medicamentosa. Após seguimento de 1 ano, o paciente está bem.

Keywords: IgG4-related disease; iliac artery aneurysm; iliofemoral bypass; vasculitis.

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Conflict of interest statement

Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

Figures

Figure 1
Figure 1. Computed tomography - (A) Volume rendered image- anteroposterior view showing left external iliac artery aneurysm (yellow arrow); (B) cross-sectional image showing aneurysmal dilation of left external iliac artery with intramural thrombus (blue arrow). The right external iliac artery and bilateral internal iliac arteries are normal.
Figure 2
Figure 2. Intra-operative images (A) Large left external iliac artery aneurysm with proximal (blue silastic tape looping left EIA) and distal (red silastic tape looping left CFA) vascular control with Silastic tapes; (B) Reconstruction with 8mm polyester graft.
Figure 3
Figure 3. (A) Thickened arterial wall with intimal and adventitial thickening and complete loss of elastic tissue from media; (B) perivascular plasma cell-rich inflammation, which had abundant IgG4-positive cells (inset).
See this image and copyright information in PMC

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