Abstract
Iliac artery aneurysm rupture usually causes acute hemorrhagic shock requiring urgent intervention, whereas chronic contained rupture is rare and seldom reported. An 86-year-old male with hypertension presented with sudden lower back and left lower limb pain causing difficulty in walking. Four weeks later, his back pain improved; however, intermittent claudication persisted. Computed tomography and magnetic resonance imaging revealed a large retroperitoneal hematoma due to rupture of the left iliac artery aneurysm and occlusion of the iliac arteries. Despite treatment recommendations, conservative management was selected in accordance with the patient's preference. Five months later, with persistent claudication and aneurysm enlargement, endovascular treatment was performed. Using intravascular ultrasound, we crossed the true lumen and deployed a stent graft from the common to external iliac artery, achieving reperfusion without endoleak. This case report highlights the chronic course of a ruptured common iliac artery aneurysm associated with iliac artery occlusion and massive retroperitoneal hematoma.