Rotura de pseudoaneurisma ilíaco como complicación tardía de cirugía de bypass aortobifemoral: a propósito de un caso y revisión de la bibliografía

Introduction. In patients with an aorto-bifemoral bypass due to an aneurysmal pathology, the appearance and/or growth of an excluded iliac aneurysm is rare.we report a case that began with the rupture of a huge pseudoaneurysm in the common iliac artery as a delayed complication of surgery performed in arder to introduce an aortobifemoral bypass. Case report.A 70-year-old mole, who had prenously undergone surgery involving resection of the aneurysm and insertion of an aortobifemoral bypass to treat an abdominal aortic aneurysm 13 years befare The patient was admitted as an emergency due to hypovolemic shock, with previous clinical symptoms of abdominal pain in the hypogastric region and dizziness with loss of consciousness. The examination revealed pain in the abdomen with palpation of a mass in the left-hand side of the abdomen. A computerised tomography scan of the abdominal-pelvic region showed a large retroperitoneal haematoma on the left side which displaced the kidney upwards and extended towards the pelvis It also produced a displacement of the left branch of the aorto-bifemoral bypass, although no leakage of contras, from the retroperitoneal vessels was observed. A medial lapartomy revealed an important, retroperitoneal haematoma on the left-hand side which encompassed the kidney; a left-side nephrectomy was performed and an old gian, haematoma of about, 15 cm was extracted. Removal of the last, layer of the stratified thrombus made it possible to identify the bleedmg point causing the pseudoaneurysm, and it was joined with double ligation and a point of transfixation. Conclusions. Given the history of aorto-bifemoral bypass with exclusion of iliac aneurysms and the discovery of a false iliac aneurysm, the chronic maintained rupture of an aneurysm in the common iliac artery fed in a retrograde manner by hypogastric circuits, was established as the origin of the development ofa delayed-rupture pseudoaneurysm. [ANGIOLOGÍA 2009; 61: 219-24]