Symptomatic abdominal aortic aneurysm (AAA) presenting as unilateral lower limb swelling: A case report

The abdominal aorta is the most common site of true arterial aneurysm, predominantly affecting the segment below the renal arteries [1]. Typically, they are now diagnosed as asymptomatic incidental findings on abdominal imaging for unrelated pathology/symptoms. Symptomatic aneurysms typically present with pain localised to the abdomen, back, or flank [2]. An extremely uncommon scenario is presentation due to the sequelae of compression of the Inferior Vena Cava (IVC). Previously, open surgical repair has been the treatment modality of choice in such cases [3].

We describe the case of a symptomatic infra-renal AAA presenting with lower limb oedema and shortness of breath due to compression of the IVC which resulted in caval thrombosis and associated embolic disease in the form of a pulmonary embolus (PE). Novel endovascular techniques allowed for management via minimally invasive surgery in the form of endovascular aneurysm repair (EVAR) which avoided the high morbidity and mortality of the previous standard of care, open surgery.

This resulted in a short duration of admission with resolution of clinical symptoms by follow-up at six-weeks post intervention.

This case highlights that the endovascular management of symptomatic AAA's resulting in caval thrombosis may offer a viable alternative to open repair with decompression.