Isolated internal iliac artery infected pseudoaneurysm occlusion using endovascular coil embolisation

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Infectious Diseases

Background:

• Sacroiliitis and gluteal abscesses can present with complex complications.
• Infectious pseudoaneurysms, particularly of the internal iliac artery, are uncommon but serious.
• Previous methicillin-resistant Staphylococcus aureus (MRSA) septicaemia can predispose to vascular complications.

Observation:

• A 34-year-old male presented with gluteal swelling and MRI-diagnosed sacroiliitis with an intramuscular abscess.
• Post-drainage, persistent bleeding led to CT angiogram revealing a pseudoaneurysm of the anterior branch of the right internal iliac artery.
• The patient had a history of Abrus precatorius poisoning complicated by MRSA septicaemia.

Findings:

• Digital subtraction angiography confirmed the pseudoaneurysm.
• Successful endovascular coil embolisation of the internal iliac artery was performed.
• Treatment was supported by culture-specific antibiotics and wound debridement.

Implications:

• Infected internal iliac artery pseudoaneurysms should be considered in complicated sacroiliitis cases.
• Endovascular coil embolisation is a viable treatment for complex pseudoaneurysms in challenging locations.
• This case highlights the importance of considering rare vascular complications following severe infections.