Case report iliac aneurysm

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Case report iliac aneurysm

  1. 1. CASE REPORTS Isolated aneurysm of the iliac artery, Surgery Department Vascular (link to view this information.) Isolated aneurysm of iliac artery (Case report) AUTHORS: * Dr. John Benalcázar Freire.ABSTRACT INTRODUCTIONIliac aneurysms are a rare disease, Aneurysms isolated iliac arteryusually the etiological cause without an abdominal aorticdegeneration of the arterial wall aneurysm (AAA) associated, are(atherosclerosis), growth is rare. Isolated aneurysms of the iliacunfortunately silent about what is artery with a prevalence of 0.3% andrequired for an adequate diagnosis and represent only 0.6% of aortoiliacphysical examination when it is aneurysms.symptomatic symptoms aregastrointestinal, urologic and / or Their location makes the diagnosis and,gynecologic, the larger the aneurysm for this reason, until failurethe greater the risk of rupture and the asymptomatic for, which is associatedrisk of death for the patient. To confirm with high mortality, greater than aorticyou must first apply an echo abdomino- aneurysms.pelvic and if this be positive the nextstep is to apply for CAT and / or Its incidence is estimated at 70 perangiotomografí. 100,000 inhabitants / year in men agedIliac aneurysm should be resolved as between 65 and 75 years, and forsoon as possible by the imminent risk women in the same age group of 2 perof rupture, endovascular technique 100,000 inhabitants / year. As inwhen is the best indication even when abdominal aortic aneurysms itsthe patient is in poor condition or had incidence increases with age, beingassociated disease, the prognosis is rare under age 65.better when performing a surgicalprocedure scheduled that when The common iliac artery is affectedperforming emergency. When an more often (70 to 90%), followed byaneurysm ruptures patient mortality the internal iliac (10 to 30%), beingincreases, therefore the conventional generally respected the externalsurgical treatment is the best measure. iliac, for unknown reasons. There is a clear male predominanceKEYWORDS: iliac aneurysm, (Gender ratio of 5:1 to 16:1), and theatherosclerosis, ruptured aneurysm. majority of patients in surgical series contents are 65 to 75 years. Approximately 50% are bilateral.
  2. 2. The most common cause of these between the size and the breakdownaneurysms is atherosclerosis, although was not clearly established.other etiologies have been reported asluetic infection and associated with Mortality from rupture is high (25 topregnancy. 57%), whereas in the case of electiveAneurysms generally isolated iliac repair is below 5%. At present, mostartery asymptomatic until the time of surgeons recommended electivebreakage, however some typical repair of isolated iliac aneurysmssymptoms are gastrointestinal in one threshold with a diameter ofthird of cases as anorexia or mild approximately 3 to 4 cm in patientsabdominal pain. Genitourinary whose risk is favorable.symptoms ranging from a nonspecificcomplaints pyelonephritis ureteral The mortality rate associated withobstruction or hematuria ureter by surgical treatment of ruptured iliacerosion. One in five patients has artery aneurysms is around 33%,symptoms neurogenic compression of similar to aortic aneurysms ruptured.the obturator nerve, femoral or sciatic. The approach can be performed viaThe presence of edema of the retroperitoneal when single, or throughextremities appears in 5% of cases due a transabdominal incision if the lesion isto venous compression. The presence bilateral. It can perform the interpositionof fever is a symptom of infectious of a graft or an aortoiliac repairaneurysms. depending on the conditions of the injury. When there is a possibility ofThe deep into the pelvis location placing a minimally invasivemakes their detection by physical endovascular prosthesis in aexamination being almost programmed manner so asimpossible not conclusive in most endovascular treatment aneurysmscases, making the diagnosis isimaging. The prognosis is generally good, although some authors suggest thatCurrently the diagnostic method of there is a high tendency for recurrencechoice is computed tomography (CT), of aneurysms either ipsilateral orwhich determines the extent and contralateral.involvement of adjacent structures.Aneurysms unilateral common iliac CLINICAL CASEartery, internal and external under threeinches will be monitored annually with Patient 69 years old with a history ofultrasound. CT and MRI were used in systemic lupus erythematosus diseasethose cases in which the ultrasonic of 18 years of evolution,unavailable. thrombocytopenic purpura secondary toAccording to different series, the SLE in the same time evolution, controlmajority of aneurysms at the time of echo is detected over 7cm massdiagnosis have a size between 4 and 5 dependent iliac artery with muralcm in diameter, while the broken have thrombus and presence Doppler flowan average diameter of 6 cm. detected with this finding is decided toThe long term monitoring breakage continue joining protocol iliac aneurysmrates reported between 10 and 70% in exams is: Biometrics 12mg/dl withafter 5 years, however, the relationship hemoglobin, leukocytes and platelets 10,230 17,000. A CT scan and bone
  3. 3. scan bone suspected neo-injured and /or metastasis at L1 and L2.Angiography: 2cm abdominal aortawith signs of atherosclerosis, presenceof aneurysm of right common iliacartery diameter 8cm with muralthrombus and 1cm light with externaliliac and hypogastric right normal axisnormal left iliac. Emergency surgery is performed in the retroperitoneal hematoma which is about 2000cc, breakage of about 15mm in outer sidewall for bleeding aneurysm in the abdominal cavity of about 500cc ligation is performed iliac artery at the level of its ostium , internal iliac artery ligation and external raffia aneurysm also placed extra-anatomic bypass femorofemoral with goretex 8mm. After 48 hours in the intensive care unit,It was decided to schedule surgery for passes general wards with all pulsesaneurysm repair thrombocytopenia present in good general condition. Inafter compensating for hematology and subsequent checks the patient is inbone biopsy result review to assess good condition.patient survival, but in the process thepatient decompensation characterizedby acute abdominal pain andhypotension, emergency admission isdone with diagnosis of injured iliacaneurysm; requested in the TACevidence that dye leakage, aneurysmedge indistinguishable, aneurysmal wallrupture, darkening of the iliopsoasmuscle and high density mass.Biometrics 8mg/dl shows hemoglobin.
  4. 4. Aneurysms isolated iliac artery disease displacement of the aneurysm,are a little emergency happens to the operatingas reported frequent work Rozhl and room for surgical correction of rupturedcollaborators, with an incidence of iliac aneurysm.0.03%. Due to the lack of experienceyou have with this disease, its natural The surgical approach in this case willhistory is not well known. Indeed, rates be decided by the transabdominal routeof breakage most familiar are the surgical groupnot been well established, and the also by the poor condition of thedifferences to assess this aspect patient, concomitant factors such asbetween common iliac arteries, internal thrombocytopenia (17000), severeand external to a specific size. anemia, blood loss and as the road that had more experience the surgical team,In the series published by Minato raffia underwent aneurysm, ligation ofdescribes the clinical picture is not internal and external iliac arteries andspecific enough. The reasons for placed extra-anatomic bypassconsultation are related to the femorofemoral to restore the flow of thecommitment of neighboring organs like right leg with goretex 8mm. Althoughkidney, ureters, colon and rectum, so there are some reports of bilateralyou need to have a high index of hypogastric occlusion without majorsuspicion. In our case it was an complications have been reportedincidental finding on a routine incidences of up to 80% of buttockabdominal echo was the presence of a claudication, ischemic colitis, erectilemass of more than 7 cm dependent dysfunction and even serious pelviciliac artery with Doppler flow inside. ischemia, especially before an inferiorAngiography is requested following the mesenteric artery occluded also in thisaneurysm diagnostic algorithm in the case was kept the left iliac axis so thatsame primitive is evidence 8cm iliac the risk of this type of ischemia doesaneurysm without signs of cracking, not exist.with mural thrombus and flow within,the iliac artery and aorta are sized There retroperitoneal approach fornormal. Surgery is planned repair of handling unilateral aneurysms notaneurysm risk of rupture rates reported injured and programmed routine thatbetween 10 and 70% at five years, with provides a best exposure and providesa mortality rate in untreated patients greater choice for correction.90%. And is expected to compensatefor the end of thrombocytopenia and Currently the management of isolatedinvestigate suspected neoplasm lumbar iliac aneurysm is best via endovascularspine. S While awaiting the outcome of therapy, which continues to evolve astherapy established by hematology and improved refining devices. Thebone biopsy to surgery and repair the endovascular management has a veryaneurysm, in such circumstances high success rate with low morbiditypatient clinical picture characterized by technical as shown by the number ofsevere abdominal pain, hypotension, it Sahgal et al and Sanchez work with 35is offset emergency and requested aneurysms, which showed only aemergency tomography evidenced technical failure, the monitoring wassigns of iliac wall rupture, aneurysm done 13 and 72 months, during whichindistinguishable edge, obscuring the there were five deaths from causesleft psoas muscle and anterior other than the aneurysm. The
  5. 5. endovascular management is a safe Surgery, Firth Edition.alternative to medium term in patients Philadelphia: Saundersat high surgical risk, especially useful in Company; 2000. pp 1246-1280.those with medical contraindications, 2. Feinberg RL, Trout HH. Isolatedsurgical and anatomical open handling. Iliac Artery aneurysm in StanleyEndovascular therapy is an alternative JC, Ernst CB Editors. Currenttreatment with comparable results to Therapy in Vascular Surgery,traditional surgery, indicated in patients Fourth Edition. St Louiswith high surgical risk for diseases Missouri: Mosby; 2001. pp 313-attendant. In some cases it is 316.postulated as the first indication. Has 3. Hood DB, Hodgson Kj.advantages over surgery, such as a Angioplastia transluminallower rate of mortality, no general percutánea y colocación deanesthesia is required, less blood loss endoprótesis para laand recovery time and shorter hospital enfermedad oclusiva de lastay. As for the disadvantages, we arteria ilíaca. Clínicasshould consider mycotic Quirúrgicas de Norte América.pseudoaneurysms by the implicit risk of Cirugía endovascular y vascularinfection of the device, but has already y vascular mínimamentebeen successful endovascular penetrante 1999; vol 3. pp 571-treatment in such cases. 72. 4. Sahgal A, Veith FJ, Lipsitz E.In cases of ruptured iliac aneurysm Diameter changes in isolatedexperience in this type of surgery is iliac artery aneurysms 1 to 6minimal so you can not generalize its years alter endovascular graftuse. In our institution we started a few repair. J Vasc Surg 2001; 33:years ago peripheral endovascular 289-94; discussion 294-5.procedures, but at no time have the 5. Serracino-Inglott F, Myers P. Antechnology and experience sufficient to alternative to aorto-uni-iliacresolve such cases in this way. EVAR and femoro-femoral crossover in a patient having anIn bilateral aneurysms and patients in aorto-iliac aneurysm with angood general condition should be occluded external iliac artery.preferred or bifemoral aortobiilíaco Eur J Vasc Endovasc Surgbridge, preserving as much as possible, 2007; 33: 575-7.the circulation of the internal iliac this 6. Cardon JM et al: Endoprosystembecause in these patients there is a I: A multicentric French study. Jhigh tendency to develop an abdominal Cardiovasc Surg 1996: 37: 45-aortic aneurysm (AAA). For patients in 50.poor general health, or with severe 7. Ricci MA, Najarian K, Healeycomorbidities, should be managed with CT. Successful endovascularstents. treatment of a ruptured internal iliac aneurysms. J Vasc Surg.REFERENCES 2002; 35: 1274-6. 8. Dosluoglu HH, Dryjski ML, 1. Cronenwett MD, Krupski WC, Harris LM. Isolated iliac artery Rutherford RB. Abdominal Aortic aneurysms in patients with or and Iliac Aneuriysms. In without previous abdominal Rutherford R, editor. Vascular
  6. 6. aortic aneurysm repair. Am J artery bypass in endovascular Surg. 1999; 178: 129-32. repair of abdominal aortic9. Hechelhammer L, Lachat ML, aneurysms with bilateral iliac Wildermuth S, Bettex D, Mayer artery aneurysms. J Vasc Surg D, Pfammatter T. Midterm 2006; 44: 1170-5. outcome of endovascular repair 16. Greenberg RK, West K, Pfaff K, of ruptured abdominal aortic Foster J, Skender D, Haulon S, aneurysms. J Vasc Surg. 2005; ET AL. Beyond the aortic 41: 752-7. bifurcation: branched10. Ohki T, Veith Fj. Endovascular endovascular grafts for grafts and other image-guided thoracoabdominal and aortoiliac catheterbased adjuncts to aneurysms. J Vasc Surg 2006; improve the treatment of 43: 879-86. ruptured aortoiliac aneurysms. 17. Pitoulias GA, Donas KP, Schulte Ann Surg. 2000; 232: 466-79. S, Horsch S, Papadimitriou DK.11. Bierdrager E, Lohle PN, Isolated iliac artery aneurysms: Schoemaker CM, Lampmann endovascular versus open LE, van BergHenegouwen DP, elective repair. J Vasc Surg Hamming JF. Successful 2007; 46: 648-54. emergency stenting of acute 18. Warrwn MJ, Fabian S, Tisi P. ruptured false iliac aneurysm. Endovascular PTFE-covered Cardiovasc Intervent Radiol. stent for treatment of an external 2002; 25: 72-3. iliac artery pseudoaneurysm in12. Williamson AE, Annunziata G, the presence of chronic Cone LA, Smith J. Endovascular infection. Cardiovasc Intervent repair of a ruptured abdominal Radiol 2007: 30: 770-3. aortic and iliac artery aneurysm 19. Gabrielli R, Irace L, Felli MM, with an acute iliocaval fistula Alunno A, Rizzo AR, ET AL. secondary to lymphoma. Ann Classic and endovascular Vasc Surg. 2002; 16: 145-9. surgical management of isolated13. Lee WA, Hirneise CM, Tayyarah iliac artery aneurysms. Minerva M, Huber TS, Seeger JM. Cardioangiol 2007; 55: 133-48. Impact of endovascular repair 20. Tielliu IF, Verhoeven EL, on early outcomes of ruptured Zeebregts CJ, Prins TR, Oranen abdominal aortic aneurysms. J BI, Van den Dungen JJ. Vasc Surg. 2004; 40: 211-5. Endovaascular treatment of iliac14. Moise MA, Woo EY, Velázquez artery aneurysms with a tubular OC, Fairman RM, Golden MA, stent-graft: mid-term results. J Mitchell MEet al. Barriers to Vasc Surg 2006; 43: 440-5. endovascular aortic aneurysm repair: past experience and implications for future device development. Vasc Endovasc Surg 2006; 40:197-203.15. Unno N, Inuzuka K, Yamamoto N, Sagara D, Suzuki M, Konno H. Preservation of pelvic circulation with hypogastric

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