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Case Reports
. 2023 May 1;15(5):e38374.
doi: 10.7759/cureus.38374. eCollection 2023 May.

Multiple and Multidirectional Fissure Bleedings in a Patient With a Spontaneous Isolated Dissection of the Iliac Artery

Sei Komatsu  1 , Satoru Takahashi  1 , Chikao Yutani  1 , Mitsuhiko Takewa  1 , Tomoki Ohara  1 , Kazuhisa Kodama  1
Affiliations
Case Reports

Multiple and Multidirectional Fissure Bleedings in a Patient With a Spontaneous Isolated Dissection of the Iliac Artery

Sei Komatsu et al. Cureus. .

Abstract

A 63-year-old man with a history of hypertension and dyslipidemia on medication was found to have an enlargement of an asymptomatic iliac artery aneurysm with an ulcer-like projection on computed tomography angiography. The longer and shorter diameter of the right iliac was increased from 24.0 × 18.1 mm to 38.9 × 32.1 mm over four years. Preoperative non-obstructive general angiography revealed multiple, multidirectional fissure bleedings. Fissure bleedings were found where computed tomography angiography appeared normal at the aortic arch. He was diagnosed with spontaneous isolated dissection of the iliac artery and was treated successfully with endovascular treatment.

Keywords: angioscopy; aorta; aortic dissection; aortic injury; fissure bleeding; iliac artery; isolated aortic dissection of the iliac artery; non-obstructive general angioscopy.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. A series of computed tomography angiography images.
A. The iliac artery aneurysm four years ago (an arrow). B. The iliac artery aneurysm on admission (an arrow). C. Three-dimensional reconstruction of the aorta. Calcification was found predominantly in the aortic arch.
Figure 2
Figure 2. Angioscopic images of the iliac artery aneurysm without (left) and with captions (right).
A. Multiple and multidirectional fissure bleedings. B. Bleedings from large fissures.
Figure 3
Figure 3. A series of angioscopic images at an interval of 10 frames for a fissure. A video was recorded at 30 frames per second.
A red line at the fissure becomes thicker and thinner, suggesting that blood flows to and fro between the aortic wall and subintima (yellow dotted lines).
Figure 4
Figure 4. A series of images for an intramural hematoma similar to the wall painting near the fissure bleedings shown by non-obstructive general angioscopy.
The intramural hematoma changed its shape.
Figure 5
Figure 5. A schematic image of spontaneous ruptured aortic plaques detected by non-obstructive general angioscopy.
A. The thoracic aorta. B. The abdominal aorta P: puff rupture; E: erosion; FB: fissure bleeding
See this image and copyright information in PMC

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