Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan.
Vascular. 2022 Dec;30(6):1192-1195. doi: 10.1177/17085381211041323. Epub 2021 Aug 12.
Intercostal artery aneurysm (IAA) is a very rare condition. Interestingly, only one study reported a case of intercostal aneurysm caused by an arteriovenous fistula (AVF). Here, we report the case of a patient with non-ruptured isolated giant true IAA caused by an AVF (size, 28 × 41 mm).
Treatment options for IAA include open surgery and endovascular treatment (EVT). We chose EVT, as it is minimally invasive. The right 11th intercostal artery and aneurysm diverged from the aorta. Two outflow arteries, one inflow artery, and an AVF from the aneurysm were confirmed, and coil embolization was performed. The artery of Adamkiewicz did not communicate with the right 11th intercostal artery. We performed angiography and confirmed occlusion of IAA with endoleak.
There were no clinical findings indicative of spinal cord infarction after treatment. The patient did not develop complications and was discharged the day after treatment. Endoleak was not observed on computed tomography angiography findings at 1 month after treatment.
In our patient, an AVF might have caused IAA. Endovascular treatment for non-ruptured isolated giant IAA is a safe and minimally-invasive treatment. We found that performing EVT is beneficial when the size of the IAA exceeds 30 mm.
肋间动脉动脉瘤（IAA）是一种非常罕见的疾病。有趣的是，仅有一项研究报道了一例由动静脉瘘（AVF）引起的肋间动脉瘤病例。在这里，我们报告了一例由 AVF 引起的未破裂孤立性巨大真性 IAA 患者（大小为 28×41mm）。
IAA 的治疗选择包括开放手术和血管内治疗（EVT）。我们选择 EVT，因为它具有微创性。右第 11 肋间动脉和动脉瘤从主动脉分支出来。确认有两条流出动脉、一条流入动脉和来自动脉瘤的 AVF，进行了线圈栓塞。Adamkiewicz 动脉与右第 11 肋间动脉不连通。我们进行了血管造影，确认 IAA 闭塞伴内漏。
治疗后无脊髓梗死的临床发现。患者未发生并发症，并在治疗后第二天出院。治疗后 1 个月的 CT 血管造影未见内漏。
在我们的患者中，AVF 可能导致了 IAA。对于未破裂的孤立性巨大 IAA，血管内治疗是一种安全且微创的治疗方法。我们发现，当 IAA 的大小超过 30mm 时，进行 EVT 是有益的。
