Corkscrew external iliac artery

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Coiling of the internal carotid arteries is well described and is thought to be a consequence of abnormal embryological development. It can cause symptomatic embolization. Coiling of other peripheral arteries is rare. We report a corkscrew external iliac artery.

A 65-year-old man presented with a 2-year history of increasing right foot claudication. At presentation, he was starting to complain of night pain in the right foot. He had never smoked, he was not diabetic, and there were no previous medical problems. His family history was unremarkable. On clinical examination, the foot looked pale, but there were no trophic changes. He had a normal right femoral pulse but no palpable pulses below this.

An angiogram performed through right common femoral antegrade access showed emboli in the profunda branches, popliteal artery occlusion, and emboli in the calf vessels (A). A computed tomography angiography of the aorta and iliac vessels revealed a tortuous right external iliac artery that had a corkscrew pattern (Cover, B). Despite an attempt at popliteal embolectomy and femorodistal bypass, the foot remained increasingly ischemic and eventually required amputation.

We believe this is only the second report in the English literature of coiling of the external iliac artery. The first, by Milic et al,¹ reported a 72-year-old man who presented with an ischemic ulcer. The coiled external iliac artery was resected and an end-to-end anastomosis performed. There has been a second report in French.²

B shows that this case may be associated with proximal patency of the sciatic artery, but this vessel is not in continuity with the common femoral or superficial femoral artery.

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References 

1. Milic DJ, Zivic SS, Perisic ZD, Mihailovic DS, Ignjatovic NS, Radovanovic ZL. Coiling of the right external iliac artery with atherosclerotic plaque as a cause of ischaemic ulcer on the toe: report of a case. Surg Today. 2007;37:1090–1092
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2. Richoz B, Hessler C. Helicoidal coiling of the iliac artery. J Radiol. 1988;69:29–31
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