Urgent Endovascular Treatment of Iliac Artery Pseudoaneurysm in Patient with Ehlers-Danlos Syndrome: A Case Report

Aleksandar Gjoreski; Ivona Jovanoska; Gjorgi Dungevski; Nikola Lazovski; Menka Lazareska

doi:10.3889/oamjms.2020.5348

Authors

Aleksandar Gjoreski Department of Diagnostic and Interventional Radiology, City General Hospital “8th September”, Skopje, Republic of Macedonia
Ivona Jovanoska Department of Diagnostic and Interventional Radiology, City General Hospital “8th September”, Skopje, Republic of Macedonia
Gjorgi Dungevski Department of Diagnostic and Interventional Radiology, City General Hospital “8th September”, Skopje, Republic of Macedonia
Nikola Lazovski University Clinic of Vascular Surgery, “St. Cyril and Methodius” University, Skopje, Republic of Macedonia
Menka Lazareska University Clinic of Radiology, “St. Cyril and Methodius” University, Skopje, Republic of Macedonia

DOI:

https://doi.org/10.3889/oamjms.2020.5348

Keywords:

Ehlers-Danlos Syndrome, vascular complication, endovascular treatment, covered stent, pseudoaneurysm

Abstract

BACKGROUND: Ehlers-Danlos syndrome (EDS) type IV is a heritable disorder of connective tissue that is mainly associated with vascular maladies such as aneurysms, pseudoaneurysms, and dissections with or without spontaneous rupture. Historically, vascular complications in EDS IV have been treated conservatively whenever possible, due to the high morbidity and mortality after vascular interventions, whether open or endovascular. We present a case of a ruptured pseudoaneurysm of the right common iliac artery in a 18-year-old male, who was successfully treated by endovascular approach and later diagnosed with EDS type IV.

CASE PRESENTATION: A 18-year-old male patient was admitted in ER with sharp pain in the right hypogastrium, hypotensive and with reduced blood parameters. Multiphasic modern computed tomography (MDCT) scan of abdomen and pelvis revealed massive ride sided pelvic and retroperitoneal hematoma. The presence of pseudoaneurysms on both common iliac arteries (CIA) was detected, with small ulcer on the right side and a focal dissection on the left side. An urgent endovascular repair of the ruptured pseudoaneurysm on the right CIA with covered stent was performed. Patient’s laboratory parameters and clinical status improved significantly within the next few days.

CONCLUSIONS: Vascular repair in EDS-IV patients carries significant risk and should be indicated very carefully. Endovascular treatment for these patients is feasible and should be considered as an alternative to open surgery in some challenging cases as this one.

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