PMC4834720_01
CTA showing markedly ectatic and dilated common and external iliac arteries up to 2.9 cm, dilated common iliac up to 5.7 cm in diameter, large 2.2 cm wide by 4.4 cm long profunda AVF to femoral vein with a calcified fistula pseudoaneurysm, and multiple embolized smaller AVFs and collaterals. Also shown is a pseudoaneurysm at the left common femoral access site, which resolved on subsequent imaging.
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CT angiography was performed revealing a normal right iliac artery and vein, dilated and tortuous distal aorta, left illiac artery and vein, dilated SFA and profunda branches, large profunda to femoral vein (FV) AVF, extensive collateralization, and multiple smaller mid-thigh AVFs (Fig. 1).
Diagnostic digital subtraction angiogram revealing numerous, tortuous profunda collaterals.
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Given the patient's young age, lack of commercially available peripheral stent graft with adequate diameter, and reluctance to use an aortic stent graft off label, we recommended an open repair (Fig. 2).
The findings on thigh exploration were consistent with CTA. Dilated and tortuous profunda artery dissected and blue vessel loop on the profunda to femoral vein.
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The patient returned to the OR one week later for definitive profunda AVF exclusion with minimal venous bleeding and adequate vessel control despite a very difficult dissection (Fig. 3).
CTA at 18 months follow up showing persistent exclusion of the AVF by embolic material and stable aneurysmal changes.
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Follow up imaging at 1 year showed persistent occlusion of the AVF (Fig. 4).