An uncommon presentation and hybrid approach for the management of an unruptured 8 cm common iliac artery aneurysm

INTRODUCTION: Common Iliac Artery Aneurysms are rare in the general population and can be difficult to diagnose. PRESENTATION OF CASE: An 82-year-old lady initially presented to her GP with non specific symptoms, but was found to have a right iliac fossa mass on examination. Initial Blood Tests and clinical observations were unremarkable. A CT scan demonstrated a large, 8 cm Isolated Right Common Iliac Aneurysm. She was admitted following the scan for monitoring and surgical intervention. In view of her mild frailty, she underwent a hybrid approach: Right Aorto-Uni-Iliac Stent Graft and Right to Left femoro-femoral crossover graft and right internal iliac artery embolization. DISCUSSION: We discuss the rarity, variety of clinical presentations and aetiology of Common Iliac Artery Aneurysms. These aneurysms are at high risk of rupture and in the elective setting, many are repaired when they reach over 3.5 cm. With the advancement and preference of minimally invasive techniques, Endovascular Aneurysm Repair (EVAR) is replacing Open Surgery. In some instances, such as our case, the anatomy is unsuitable for a standalone EVAR procedure. Thus a hybrid operation was performed. CONCLUSION: Common Iliac Artery Aneurysms should be considered in a differential diagnosis of lower abdominal mass. If presenting in this manner, the aneurysm can be of significant size and at high risk of rupture, requiring urgent surgical intervention.