Abstract
BACKGROUND: A ruptured internal iliac artery aneurysm that perforates the common iliac vein is a rare but fatal condition. CASE SUMMARY: An 80-year-old man presented with back pain and anorexia. Contrast-enhanced computed tomography revealed a ruptured internal iliac artery aneurysm that perforated the right common iliac vein and caused acute heart failure. The fistula was temporarily closed using a dilated balloon that was promptly inserted through the right femoral vein, resulting in hemodynamic stability. Endovascular treatment including coil embolization was performed. Computed tomography after surgery showed the absence of arteriovenous flow and no endoleaks. The patient was discharged 30 days after surgery. DISCUSSION: An arteriovenous fistula can induce hemodynamic instability. TAKE-HOME MESSAGE: Temporary balloon occlusion of an arteriovenous fistula via the femoral vein can create hemodynamic stability, thus enabling emergency endovascular repair under stable conditions.