Fatal rupture of a flow-related Iliac artery aneurysm associated with an enormous arteriovenous malformation of abdominal wall and left thigh

We report the first case of a fatal rupture of a flow-related iliac artery aneurysm (IAA) associated with an enormous arteriovenous malformation (AVM). A 47-year-old male presented with an extensive AVM involving the abdominal wall and left thigh, alongside a left IAA measuring 4.16 cm in diameter. Despite multiple AVM-targeted treatments and close IAA monitoring, the aneurysm ruptured after one year of follow-up, causing hemorrhagic shock. Emergency endovascular repair was performed, but the patient succumbed to uncorrected disseminated intravascular coagulation post-procedure. This outcome suggests the need for a more proactive management strategy for flow-related aneurysms in AVM patients.