title: Successful surgical repair of an ilio-iliac arteriovenous fistula associated with a ruptured common iliac artery aneurysm.
abstract: BACKGROUND
  We describe the case of an 86-year-old man with an ilio-iliac arteriovenous fistula (AVF) resulting from a ruptured aneurysm. This condition rarely occurs, has a high mortality rate, and was successfully treated via surgery.
  
  
  METHODS
  The patient presented with a temporary loss of consciousness and left leg edema. A pulsatile abdominal mass with vascular murmur and thrill was detected. Enhanced computed tomography showed abdominal aortic and iliac aneurysms with left common iliac vein occlusion, and the left external iliac vein was easily seen through the AVF. We directly sutured the AVF and performed aneurysmectomy and prosthetic graft replacement. During surgery, placement of occlusive balloon catheters through the AVF minimized intraoperative bleeding. The patient recovered uneventfully, and swelling of the left leg was immediately reduced after surgery.
  
  
  CONCLUSIONS
  Although rare, AVFs can be life-threatening, and urgent treatment and intensive care are occasionally needed. Surgical management of AVF requires a definitive preoperative diagnosis and control of venous bleeding during surgery. Fulfilling these major requirements can potentially reduce morbidity and mortality in patients with AVFs. Interestingly, there was no sign of high-output heart failure throughout the treatment course due to compression of the aneurysm and consequent blood flow failure to the left iliac vein.
  
  
  CONCLUSIONS
  Using the balloon occlusion technique, we were able to minimize blood loss during open repair. Use of multiple imaging modalities facilitates correct preoperative diagnosis and consequently improves surgical outcome.
authors.affiliation: Department of Cardiovascular Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Duesseldorf, Germany. Electronic address: Makoto.Iijima@med.uni-duesseldorf.de.
authors.forename: Makoto
authors.initials: M
authors.lastname: Iijima
authors.affiliation: Division of Cardiovascular Surgery, National Hospital Organization, Hokkaido Medical Center, Sapporo, Hokkaido, Japan. Electronic address: kawasaki.1180@hok-mc.hosp.go.jp.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Kawasaki
authors.affiliation: Division of Cardiovascular Surgery, National Hospital Organization, Hokkaido Medical Center, Sapporo, Hokkaido, Japan. Electronic address: ishibashi@hok-mc.hosp.go.jp.
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Ishibashi
keywords: Iliac artery aneurysm; Iliac vein occlusion; Ilio-iliac arteriovenous fistula; Surgical repair