PMC9464869_01
Digital subtraction angiography (DSA) of the right inferior vena cava examination. (A-H).Before thrombolysis surgery, DSA of the patient reveals occlusion of the right common iliac vein (CIV) and right external iliac vein, with plenty of collateral vessels and extensive filling defects in the proximal and middle segments, exhibiting a stenosis degree of 50%-90% (A-F) femoral vein, (G) popliteal vein, (H) deep calf vein; the arrows and circles of different colors in the figures indicate the focus]. (I-K). After thrombolysis surgery, DSA examination of the patient shows recanalization of the femoral vein (the arrows and circles of different colors in the figures indicate the focus).
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Venography ( Figures 1A-H ) revealed occlusion of the right common iliac vein (CIV) and right external iliac vein with several collateral vessels, occlusion in the distal segments, and extensive filling defects in the proximal and middle segments of the right femoral vein, exhibiting a stenosis degree between 50%-90%.
Abdominal computed tomography angiography (CTA) examination. Abdominal CTA images show dynamic progression of pseudoaneurysm based on drug intervention before bare stent implantation: the area of pseudoaneurysm of the right CIA is larger, while the area of the pseudoaneurysm of the left IIA is smaller. (A-C). On admission abdominal CTA revealed rupture of the right common iliac artery (CIA) and left internal iliac artery (IIA), which was complicated by the formation of a pseudoaneurysm. (D-F). After 1 month of drug therapy, abdominal CTA revealed that the area of the pseudoaneurysm of the right CIA was larger than that at the first examination, while the area of the pseudoaneurysm of the left IIA was similar to that at the first examination. (G-I). After 10 months of drug therapy, abdominal CTA revealed that the area of pseudoaneurysm of the right CIA was larger than that at the second examination, while the area of pseudoaneurysm of the left IIA was smaller than that at the second examination.
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The contrast agent was observed to infiltrate the cyst from the left internal iliac artery (IIA) on enhanced scan, suggesting rupture of the right CIA and left IIA, complicated by the formation of a pseudoaneurysm ( Figures 2A-C ). However, the area of the pseudoaneurysm of the left IIA decreased from 5.5 cmx4.3 cm to 3.4 cmx3.0 cm, and no contrast agent was observed flowing gradually in the area of the left IIA pseudoaneurysm on enhanced scan ( Figures 2D-F,G-I ).
Imaging manifestations of pseudoaneurysm of the right CIA during bare stent implantation and after operation. (A-C). After bare stent implantation, DSA of the right inferior vena cava showed the following findings: the signal within the stent was unobstructed in the right CIA; a small amount of contrast agent at the stent in the right CIA still flowed into the cavity of the pseudoaneurysm and the size of the pseudoaneurysm became small; there was no contrast agent in the area of the left IIA pseudoaneurysm. (D-F). After 4 months of bare stent implantation, abdominal CTA showed that there is a small amount of contrast agent at the stent in the right CIA that continues to flow into the cavity of the pseudoaneurysm, leading to a slight increase in the size of the pseudoaneurysm. However, there was no contrast agent in the left IIA pseudoaneurysm area. (G, H). After 11 months of bare stent implantation, abdominal CTA showed a small amount of contrast agent at the stent in the right CIA that continued to flow into the cavity of the pseudoaneurysm, and the size of the pseudoaneurysm was similar to that of (D-F). However, there was no contrast agent in the left IIA pseudoaneurysm area.
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Duplicate 10 mmx6 cm bare stent (Bard  Luminexx ) implantation was performed in the right CIA, and postoperative angiography revealed contrast agent blowing into the pseudoaneurysm cavity ( Figures 3A-C ). However, no contrast agent was observed in the area of the left IIA pseudoaneurysm ( Figures 3D-F, G, H ,  Figures 4A-C ).
Imaging manifestations of pseudoaneurysm of the right CIA before and after covered stent implantation. (A-C). After 27 months of bare stent implantation, abdominal CTA showed the following findings: The size of the pseudoaneurysm was obviously increased compared to that post-operation, because the contrast agent continuously flows into the cavity of the pseudoaneurysm. However, there was no contrast agent in the left IIA pseudoaneurysm area. (D-F). After covered stent implantation, DSA of the right inferior vena cava showed the following findings: There was less contrast agent blowing into the cavity of the pseudoaneurysm of the right CIA and the size of the pseudoaneurysm was decreased.
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However, no contrast agent was observed in the area of the left IIA pseudoaneurysm ( Figures 3D-F, G, H ,  Figures 4A-C ). Post-operative angiography revealed that there was less contrast agent blowing into the cavity of the pseudoaneurysm ( Figures 4D-F ).