Aneurysm of the common iliac artery presenting as a lumbosacral plexopathy

Ruptured Complex Aortoiliac Aneurysm in an Elderly Patient With a Kidney Transplant Presenting With Sciatica

Background: Common iliac artery aneurysms are uncommon, with an estimated incidence of less than 0.01% in adults and accounting for only 1% of all intra-abdominal aneurysms. While the risk of rupture is approximately 5%, it increases significantly to 29% once the aneurysm reaches 4 cm. Similarly to abdominal aortic aneurysms, common iliac artery aneurysms often develop silently, remaining asymptomatic in about 70% of cases. This report describes the treatment of a patient with a kidney transplant who underwent endovascular repair of a ruptured left common iliac artery aneurysm with a concomitant abdominal aortic aneurysm and a focal aneurysm of the right renal artery origin. Case Description: A 78-year-old male patient with a kidney transplant presented with left sciatica symptoms and was found to have a contained rupture of a 10 x 7 cm left common iliac artery aneurysm with a concomitant 8 cm abdominal aortic aneurysm and a focal 1.8 cm aneurysm of the right renal artery origin. He underwent an endovascular aneurysm repair with an Aorto-Uni-iliac stent graft and a concomitant right-to-left femoral-femoral bypass using 8 mm ringed PTFE graft and ligation of left external iliac artery to prevent retrograde flow into the left common iliac artery aneurysm. At 3-year follow-up, patient remains stable with a functioning kidney transplant and excluded aneurysms with no evidence of endoleak. Conclusion: This report describes the endovascular repair of a ruptured left common iliac artery aneurysm conducted under local anesthesia in a patient with a renal transplant and complex aneurysm anatomy. The calcification pattern observed on a non-contrast CT scan was effectively used for surgical planning, leading to a successful aneurysm repair while preserving kidney transplant function.

Brachial and lumbosacral plexopathies: A review

Diseases of the brachial and lumbosacral plexus are uncommon and complex. The diagnosis of plexopathies is often challenging for the clinician, both in terms of localizing a patient's symptoms to the plexus as well as determining the etiology. The non-specific clinical features and similar presentations to other root, nerve, and non-neurologic disorders emphasize the importance of a high clinical index of suspicion for a plexopathy and comprehensive clinical evaluation. Various diagnostic tests, including electrodiagnostic (EDX) studies, neuroimaging (including ultrasound, MRI, or PET), serologic studies, and genetic testing, may be used to confirm a plexopathy and assist in identifying the underlying etiology. EDX testing plays an important role in confirming a plexopathy defining the localization, pathophysiology, chronicity, severity, and prognosis. Given the complexity of the plexus anatomy, multiple common and uncommon NCS and an extensive needle examination is often required, and a comprehensive, individualized approach to each patient is necessary. Treatment of plexopathies often focuses on symptomatic management although, depending on the etiology, specific targeted treatments may improve outcome. This article reviews the clinical features, EDX approaches, and evaluation and treatment of brachial and lumbosacral plexopathies.

Progressive paralyzing sciatica revealing a pelvic pseudoaneurysm a year after hip surgery in a 12yo boy

Identifying extra spinal causes of a lumbar radiculopathy or polyneuropathy can be a tricky diagnosis challenge, especially in children. Among them, traumatic or iatrogenic pseudoaneurysms of iliac arteries have been seldom reported, in adults' series. The authors report an unusual case of progressive paralyzing left sciatica and lumbar plexopathy in a 12 years old boy, 12 months after a pelvic osteotomy for bilateral hip luxation secondary to osteochondritis dissecans. Spine MRI and pelvic CT angiography revealed a giant internal iliac artery pseudoaneurysm, enclosed in a chronic hematoma. The patient was successfully treated with endovascular coil embolization, and subsequent surgical hematoma evacuation. However, three months after treatment, neurological recovery was incomplete. This case highlights the importance of a rapid and extensive diagnosis work up of all causes of lower limb radiculopathies in children, including pelvic arteries lesions especially after pelvic surgery to avoid therapeutic delays that may jeopardize the chances of neurological recovery.

Endovascular management of ruptured common iliac mycotic aneurysm in an HIV-positive patient

Isolated iliac artery aneurysms are a rare entity. The majority of cases are asymptomatic and often escape detection. Mortality rates after sudden rupture and emergent surgery for iliac artery aneurysm are very high. We report a case of a 56-year-old man who presented with right hip pain masquerading as septic arthritis or psoas abscess. CT showed ruptured right common iliac artery aneurysm with extensive active extravasation into psoas with a retroperitoneal haematoma. Aneurysm was repaired using an endovascular technique. Postoperative recovery was eventful with the patient experiencing severe back pain radiating down the leg accompanied with fever. CT showed persistent, right iliopsoas haematoma and pelvic haematoma with secondary hydronephrosis. Viral screen for hepatitis B, C and HIV returned positive. The patient was started on intravenous meropenem. Fever and pain settled. Repeated CT scan showed decrease in retroperitoneal pelvic haematoma.

Diagnosis of brachial and lumbosacral plexus lesions

To most doctors, brachial and lumbosacral plexopathies are known as difficult disorders, because of their complicated anatomy and relatively rare occurrence. Both the brachial, lumbar, and sacral plexuses are extensive PNS structures stretching from the neck to axillary region and running in the paraspinal lumbar and pelvic region, containing 100000-200000 axons with 12-15 major terminal branches supplying almost 50 muscles in each limb. The most difficult part in diagnosing a plexopathy is probably that it requires an adequate amount of clinical suspicion combined with a thorough anatomical knowledge of the PNS and a meticulous clinical examination. Once a set of symptoms is recognized as a plexopathy the patients' history and course of the disorder will often greatly limit the differential diagnosis. The most common cause of brachial plexopathy is probably neuralgic amyotrophy and the most common cause of lumbosacral plexopathy is diabetic amyotrophy. Traumatic and malignant lesions are fortunately rarer but just as devastating. This chapter provides an overview of both common and rarer brachial and lumbosacral plexus disorders, focusing on clinical examination, the use of additional investigative techniques, prognosis, and treatment.

A rare cause of urinary retention: Iliac artery aneurysms

Internal iliac artery aneurysms are rare, but with a mortality approaching 50% in those that rupture, prompt diagnosis is essential. Often presentation is nonspecific; a wide variety of symptoms and signs have been encountered, illustrating a challenge in identification. We report a case of ruptured internal iliac artery aneurysm presenting as urinary retention. The importance of maintaining a broad differential in cases of urinary retention is clearly highlighted.

An unusual case of acute foot drop caused by a pseudoaneurysm

Lower extremity neurologic symptoms are a common presenting problem. Here we report the case of a 73-year-old man who developed acute right foot pain and foot drop. History, physical examination, and electrodiagnostic studies were consistent with a lumbosacral plexopathy. Imaging studies revealed an internal iliac artery pseudoaneurysm, a rare cause of acute foot drop.

Ruptured aneurysm of the common iliac artery as a cause of unilateral hip pain

Rupture of an aneurysm of the common iliac artery is a rare cause of pain in the hip. We describe an elderly hypertensive patient with an aneurysmal rupture of the left common iliac artery who presented with unilateral hip pain masquerading as septic arthritis.