Case images: percutaneous closure of an arteriovenous fistula from iliac artery to contralateral iliac vein with pseudoaneurysm.

A 28-year-old male patient was admitted following a fall from a height. Lower abdominal computed tomography revealed multiple fractures in the hip bones. Following operation by orthopedic surgeons, episodes of sinus tachycardia were present. Examination suggested hyperdynamic circulation, with a continuous murmur in the lower right quadrant of the abdomen. A re-examination of the contrast-enhanced computed tomography revealed a 4.5x4x3 cm sac arising from the right lateral sacral iliac artery branch, with early arterial filling of the left iliac vein by the right iliac. The findings were evaluated as pseudoaneurysm of the right lateral sacral artery and arteriovenous fistula (AVF) between the right iliac artery and left iliac vein. This diagnosis was confirmed by peripheral angiography (Figure A). The pseudoaneurysm and AVF were closed using the Vascular Plug System (Figure B). In the control contrast injection after closure, minimal leakage was observed. At one-month follow-up, lower abdominal contrast-enhanced abdominal computed tomography showed thrombosis of the pseudoaneurysm and closure of the AVF (Figure C, D). 319