Staged endovascular management of a ruptured common iliac artery aneurysm with iliocaval fistula and high-output heart failure.

Rupture of a common iliac artery aneurysm into the inferior vena cava is rare and can cause high-output heart failure. We report staged endovascular management in a 59-year-old man with a 70-mm right common iliac artery aneurysm and iliocaval fistula. Emergency embolization of the right internal iliac artery and endovascular repair rapidly improved heart failure (brain natriuretic peptide decreased from 1300 to 60 pg/mL at 1 week). Persistent iliolumbar artery-related type II endoleak with residual venous enhancement was treated by secondary transarterial coil embolization on postoperative day 10. A 31-mm left internal iliac artery aneurysm was subsequently excluded endovascularly. At 3.5 years, the right aneurysm sac had decreased to 35 mm without recurrent fistula or endoleak.