Secondary rupture of an iliac artery aneurysm after exclusion-bypass

We report a case of secondary rupture of a common iliac artery aneurysm into the common iliac vein. Exclusion of the iliac aneurysm had been performed 2 years earlier in association with reconstruction of an aortic aneurysm that had ruptured into the inferior vena cava. After closure of the aortocaval fistula by the endoaneurysmal route, aortobifemoral bypass grafting had been performed and a caval clip had been placed. The common iliac arteries had been sutured by the endoaneurysmal route and the right common iliac artery had been excluded by ligation of the right iliac artery. Occlusion of the inferior vena cava distal to the caval clip resulted in increased peripheral venous hypertension causing the secondary arteriovenous fistula (rupture of scrotal varices and edema of lower extremities) but prevented right cardiac insufficiency. This observation confirms the possibility of secondary rupture after treatment of an aneurysm by exclusion. Thus the inclusion-graft technique is more reliable.