Internal Iliac Artery Aneurism

Clinical History

This 77 year old man presented to hospital complaining of a painful right leg. Examination revealed a mottled, cold and markedly swollen right leg with paralysis and decreased sensation. Pulses distal to the femoral were absent. The patient's general poor state precluded surgical intervention and he died two days later. At post mortem deep vein thrombosis was present in the right leg.

Pathology

The specimen consists of aortic bifurcation, both common iliac vessels, internal and external iliacs and both femoral arteries. All vessels have been opened from behind to display their luminal surface and all show a moderate degree of atheromatous change superimposed on arteriosclerosis. The most striking abnormality is the presence of a large saccular aneurism at the origin of the left internal iliac artery. The aneurism is filled with old laminated thrombus. There is asymmetric dilatation of the right common iliac artery and the dilated region is filled with mural thrombus showing the characteristic "lines of Zahn" on its surface. A 10 cm length of adherent thrombus is seen in the right femoral artery.