A spontaneous isolated dissection of the external iliac artery in a roofer

After two days of an intensive roofing work, a healthy professional 41-year-old roofer experienced an isolated spontaneous dissection of the external iliac artery with an acute severe ischemia of the left lower extremity. The compressed true lumen, complete thrombosis of the false lumen and an overlapping dissection at the origin of the deep femoral artery necessitated an open surgery. An urgent iliofemoral bypass was constructed and external iliac artery was excluded. Connective tissue disorders were excluded by immunology, histology and genetic tests. Spontaneous dissection of the iliac artery has frequently been described in sportsmen after an exceptional physical strain. The same mechanism may also come into question following occupational overexertion. However, connective tissue or vascular wall disorders must be taken into consideration in differential diagnosis (Fig. 1, Ref. 21).