Abstract
Objective. Bilateral internal iliac artery aneurysms constitute the utmost configuration of infrarenal aortoiliac disease. We detail characteristic aortoiliac disease patterns and reconstructive techniques we have used, along with a visualized decision-making chart and a short review of the literature. Material and Methods. A retrospective, observational study of twelve clinical cases of patients with aortoiliac disease are described. Two patients had a common iliac artery aneurysm and were managed by the application of inversed stent-grafts; another case was repaired by the insertion of a standard bifurcated stent-graft flared in the right common iliac artery and with an iliac branched device in the left iliac arterial axis. Open approach was used in 5 cases and in 4 cases a combination of aortouniliac stent-grafting with femoral-femoral bypass was applied. Results. Technical success was 100%. One endoleak type Ib in a flared iliac limb was observed and corrected by internal iliac embolism and use of an iliac limb stent-graft extension. We report 100% patency rate during 26.3 months of followup. Conclusion. Individualized techniques for the management of isolated iliac or aortoiliac aneurismal desease with special concern in maintaining internal iliac artery perfusion lead to elimination of perioperative complications and long-term durability and patency rates.
Highlights
Iliac artery aneurysms (IAAs) participate in various aortoiliac aneurismal (AIA) patterns that frequently necessitate sophisticated reconstructions
External iliac artery aneurysms (EIAAs) consist < 10% of isolated IAAs [6]; isolated IIAAs represent 0.4%–1.9% of arterial aneurysms and 0.04% of AIAs [1] with 38% rupture incidence at presentation and 58–80% mortality rate
By presenting these characteristic cases, our intention was to enlighten the diverse aspects of aortoiliac repair underlining that they are combined in a complimentary and not antagonizing association; we presume that patients’ best outcome arises rather from optimum preoperative matching and not by adherence to a particular method
Summary
Iliac artery aneurysms (IAAs) participate in various aortoiliac aneurismal (AIA) patterns that frequently necessitate sophisticated reconstructions. An IAA represents a 50% arterial diameter increase, compared to normal; in absolute terms, common iliac arteries (CIAs) are considered aneurismal with diameter > 18.5 mm for men (normal: 1.23 ± 0.20 cm) and >15 mm for women (normal: 1.02 ± 0.19 cm); internal iliac artery’s (IIA) diameter, in both genders, is 0.54 ± 0.15 cm [1, 2]. Isolated IAAs (prevalence 0.008–0.03% [4]) represent 2– 11% of intra-abdominal aneurysms. External iliac artery aneurysms (EIAAs) consist < 10% of isolated IAAs [6]; isolated IIAAs represent 0.4%–1.9% of arterial aneurysms and 0.04% of AIAs [1] with 38% rupture incidence at presentation and 58–80% mortality rate. Identification of vulnerable for hypogastric ischemia patients as long as International Journal of Vascular Medicine (a)
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