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Internal iliac aneurysm presenting with lower back pain, sciatica and foot drop.

Rohit Singh1, Thomas Moores2, Mark Maddox3

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Summary

Internal iliac artery aneurysms often go undetected until rupture. This case highlights a rare presentation of sciatic nerve pain and foot drop due to a large internal iliac artery aneurysm, managed with endovascular techniques.

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Area of Science:

  • Vascular Surgery
  • Neurology
  • Radiology

Background:

  • Internal iliac artery aneurysms (IIAAs) are uncommon vascular conditions.
  • They are typically asymptomatic and discovered incidentally during imaging for other pathologies.
  • Rupture is the most common complication, often presenting as a surgical emergency.

Observation:

  • A middle-aged male presented with symptoms suggestive of sciatic nerve compression.
  • Diagnostic imaging revealed a large internal iliac artery aneurysm as the underlying cause.
  • This represents a rare clinical presentation of IIAA.

Findings:

  • The internal iliac artery aneurysm was compressing the sciatic nerve, leading to neurological deficits.
  • Endovascular management was successfully employed to treat the aneurysm.
  • This approach addressed both the vascular pathology and the neurological symptoms.

Implications:

  • This case expands the known clinical spectrum of internal iliac artery aneurysms.
  • It underscores the importance of considering vascular causes for neurological symptoms in the sciatic nerve distribution.
  • Endovascular repair offers a viable treatment option for symptomatic IIAAs, potentially avoiding open surgery.