Bilateral external iliac artery pseudoaneurysms causing urinary obstruction and acute renal failure

Marcelo Puppo Bigarella; Roberto Iglesias Lopes; Guilherme Gentile; Carolina Brito Faustino; Lais da Cunha Gamba; Guilherme Baumgardt Barbosa Lima; Henry Augusto Hoffman Melo; Grace Carvajal Mulatti

doi:10.1186/s42155-022-00302-5

Bilateral external iliac artery pseudoaneurysms causing urinary obstruction and acute renal failure

CVIR Endovasc. 2022 May 25;5(1):22. doi: 10.1186/s42155-022-00302-5.

Authors

Marcelo Puppo Bigarella¹, Roberto Iglesias Lopes², Guilherme Gentile², Carolina Brito Faustino³, Lais da Cunha Gamba³, Guilherme Baumgardt Barbosa Lima³, Henry Augusto Hoffman Melo³, Grace Carvajal Mulatti³

Affiliations

¹ Division of Urology, Department of Surgery, University of São Paulo School of Medicine, Rua Helena 218 4 floor 410 - Sartor Medicina, São Paulo, 04552-050, Brazil. marcelo.bigarella@gmail.com.
² Division of Urology, Department of Surgery, University of São Paulo School of Medicine, Rua Helena 218 4 floor 410 - Sartor Medicina, São Paulo, 04552-050, Brazil.
³ Division of Vascular Surgery, Department of Surgery, University of São Paulo School of Medicine, São Paulo, Brazil.

Abstract

Background: We report an exceedingly rare case of bilateral external iliac artery pseudoaneurysms causing urinary obstruction and acute renal failure.

Case presentation: A young man presented with acute severe bilateral testicular pain radiating to the back. Clinical and radiological workup showed bilateral external iliac artery pseudoaneurysms, which caused bilateral ureterohydronephrosis due to urinary obstruction with subsequent renal failure. Management included immediate bilateral external iliac artery endovascular repair and bilateral ureterolysis using a retroperitoneal approach, with resolution of the obstruction and successful endovascular treatment of both pseudoaneurysms. The only identifiable risk factor for cardiovascular disease was cocaine addiction.

Conclusions: This case highlights an unusual and severe clinical presentation of bilateral EIA pseudoaneurysms causing bilateral ureterohydronephrosis and subsequent renal failure. Awareness of this condition may help avoid misdiagnosis and delayed management, which is of utmost importance for a favorable outcome.

Keywords: Bilateral ureterohydronephrosis; Endovascular repair; External iliac artery; Ruptured pseudoaneurysm; Ureteral obstruction.