Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.202201192
Jornal Vascular Brasileiro
Case Report

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

Aneurisma isolado de artéria ilíaca externa - uma apresentação de caso raro de doença relacionada à IgG4

Naveen Maheshwari; Venkata Vineeth Vaddavalli; Kishore Abuji; Ajay Savlania; Ritambhra Nada

Downloads: 1
Views: 822

Abstract

Abstract: 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.

Keywords

iliac artery aneurysm, vasculitis, IgG4-related disease, iliofemoral bypass

Resumo

Resumo: 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.
 

Palavras-chave

aneurisma de artéria ilíaca, vasculite, doença relacionada à IgG4, bypass iliofemoral

References

1 Kotsis T, Louizos LA, Pappas E, Theodoraki K. Complex common and internal iliac or aortoiliac aneurysms and current approach: individualised open-endovascular or combined procedures. Int J Vasc Med. 2014;2014(22):178610. http://dx.doi.org/10.1155/2014/178610. PMid:25328706.

2 Crivello MS, Porter DH, Kim D, Critchlow JF, Scoutt L. Isolated external iliac artery aneurysm secondary to cystic medial necrosis. Cardiovasc Intervent Radiol. 1986;9(3):139-41. http://dx.doi.org/10.1007/BF02577923. PMid:3089620.

3 Kato T, Takagi H, Kawai N, Sekido Y, Umemoto T. Ruptured isolated external iliac artery true aneurysm associated with cystic medial necrosis: report of a case. Surg Today. 2009;39(8):705-9. http://dx.doi.org/10.1007/s00595-008-3898-0. PMid:19639439.

4 Tanaka CM, Matielo MF, Nakamura ET, Tiossi SR. Bilateral external iliac artery aneurysm in a young man. J Vasc Surg Cases Innov Tech. 2022;8(1):57-9. http://dx.doi.org/10.1016/j.jvscit.2021.12.006. PMid:35118216.

5 Tilson MD, Toset A, Tyrie L. Chicken embryology of human aneurysm resistant arteries. Matrix Biol. 2006;25:134. http://dx.doi.org/10.1016/j.matbio.2006.08.158.

6 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s choice - European Society for vascular surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.

7 Chatzantonis G, Schmoll L, Strübing F, Chatzantonis G, Kühner C. A surprising diagnosis in a young patient with intermittent claudication: Symptomatic isolated external iliac artery aneurysm associated with cystic media necrosis. J Vasc Surg Cases Innov Tech. 2020;6(3):352-6. http://dx.doi.org/10.1016/j.jvscit.2020.05.010. PMid:32715170.

8 Mohan IV, Adam DJ, Kurian KM, Ruckley CV. Isolated external iliac aneurysm associated with hyperhomocysteinaemia. Eur J Vasc Endovasc Surg. 1997;14(6):506-8. http://dx.doi.org/10.1016/S1078-5884(97)80134-7. PMid:9467530.

9 Bacharach JM, Slovut DP. State of the art: management of iliac artery aneurysmal disease. Catheter Cardiovasc Interv. 2008;71(5):708-14. http://dx.doi.org/10.1002/ccd.21507. PMid:18360870.

10 Umehara H, Okazaki K, Kawa S, et al. The 2020 revised comprehensive diagnostic (RCD) criteria for IgG4-RD. Mod Rheumatol. 2021;31(3):529-33. http://dx.doi.org/10.1080/14397595.2020.1859710. PMid:33274670.

11 Perugino CA, Wallace ZS, Meyersohn N, Oliveira G, Stone JR, Stone JH. Large vessel involvement by IgG4-related disease. Medicine. 2016;95(28):e3344. http://dx.doi.org/10.1097/MD.0000000000003344. PMid:27428181.

12 Wallace ZS, Zhang Y, Perugino CA, Naden R, Choi HK, Stone JH. Clinical phenotypes of IgG4-related disease: an analysis of two international cross-sectional cohorts. Ann Rheum Dis. 2019;78(3):406-12. http://dx.doi.org/10.1136/annrheumdis-2018-214603. PMid:30612117.

13 Kasashima S, Zen Y, Kawashima A, Endo M, Matsumoto Y, Kasashima F. A new clinicopathological entity of IgG4-related inflammatory abdominal aortic aneurysm. J Vasc Surg. 2009;49(5):1264-71. http://dx.doi.org/10.1016/j.jvs.2008.11.072. PMid:19217746.

14 Richardson JW, Greenfield LJ. Natural history and management of iliac aneurysms. J Vasc Surg. 1988;8(2):165-71. http://dx.doi.org/10.1016/0741-5214(88)90405-3. PMid:3294450.

15 Santilli SM, Wernsing SE, Lee ES. Expansion rates and outcomes for iliac artery aneurysms. J Vasc Surg. 2000;31(1 Pt 1):114-21. http://dx.doi.org/10.1016/S0741-5214(00)70073-5. PMid:10642714.

16 Bown MJ, Sweeting MJ, Brown LC, Powell JT, Thompson SG. Surveillance intervals for small abdominal aortic aneurysms: a meta-analysis. JAMA. 2013;309(8):806-13. http://dx.doi.org/10.1001/jama.2013.950. PMid:23443444.

17 Zerizer I, Tan K, Khan S, et al. Role of FDG-PET and PET/CT in the diagnosis and management of vasculitis. Eur J Radiol. 2010;73(3):504-9. http://dx.doi.org/10.1016/j.ejrad.2010.01.021. PMid:20172676.

18 Kuma S, Takeshima T, Ohga T, Nozoe T, Sueishi K. Superficial temporal artery aneurysm associated with immunoglobulin G4-related disease. J Vasc Surg Cases Innov Tech. 2017;3(4):243-6. http://dx.doi.org/10.1016/j.jvscit.2017.10.005. PMid:29349436.

19 Kasirajan V, Hertzer NR, Beven EG, O’Hara PJ, Krajewski LP, Sullivan TM. Management of isolated common iliac artery aneurysms. Cardiovasc Surg. 1998;6(2):171-7. http://dx.doi.org/10.1016/S0967-2109(97)00136-1. PMid:9610831.

20 Picone AL, Green RM, Ricotta JR, May AG, DeWeese JA. Spinal cord ischemia following operations on the abdominal aorta. J Vasc Surg. 1986;3(1):94-103. http://dx.doi.org/10.1016/0741-5214(86)90072-8. PMid:3941486.
 


Submitted date:
09/16/2022

Accepted date:
01/16/2023

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
643418eea9539553290d387a jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections