Internal Iliac Artery Aneurysm Research Articles

Surgical Repair of an Arteriovenous Fistula in the Posterior Wall of the Right Common Iliac Vein

We present the case of a right internal iliac artery aneurysm with arteriovenous fistula in the posterior wall of the right common iliac vein. The fistula would have been difficult to close using endovascular treatment. We strongly anticipated difficulty in controlling bleeding; therefore, we performed cardiopulmonary bypass. Closing the fistula with suture would have been difficult, so we ligated the right common iliac artery and vein around the aneurysm. Femoro–femoral bypass was also performed to preserve blood flow in the lower right leg. The use of cardiopulmonary bypass should be considered in such difficult cases.

Successful Treatment of Right Internal Iliac Artery Aneurysm Rupture with Arterio-rectal Fistula

Successful Treatment of Right Internal Iliac Artery Aneurysm Rupture with Arterio-rectal Fistula

Endovascular Repair of Isolated Internal Iliac Artery Aneurysm with the Importance of Collateral Vessels

Endovascular Repair of Isolated Internal Iliac Artery Aneurysm with the Importance of Collateral Vessels

A Rare Cause of Lower Gastrointestinal Bleed: Internal Iliac Aneurysm With Rupture into Rectum

An 85-year-old male with history of atrial fibrillation for which he was on warfarin, tobacco use, and vascular disease presented with acute onset of pulsatile rectal hemorrhage followed by unresponsiveness. Physical examination revealed confusion and tachycardia with a benign abdomen. Labs revealed a two-gram hemoglobin drop and INR of 5. The patient was resuscitated and coagulopathy was reversed. Enhanced CT abdomen/pelvis revealed a 2.2 x 1.8 cm distal right internal iliac artery aneurysm with contained rupture, evidenced by a 2.5 x 2.2 medially projecting pseudoaneurysm (Figure A). There was no enteric endoluminal extravasation of contrast to suggest a fistula, although presentation was suggestive of one. An urgent angiogram revealed an aneurysm arising from a distal branch of the anterior division of the right internal iliac artery, with no active extravasation (Figure B). Coil embolization of the outflow artery was performed (Figure C). The inflow artery to the aneurysm was then embolized and follow-up angiogram showed no additional feeding vessels into the aneurysm. Following the procedure, there was no further hematochezia and the hemoglobin remained stable. A literature search for ruptured internal iliac artery aneurysm with fistulization to the colon mainly showed cases occurring secondary to vasculitis or previous vascular reconstructive surgery. Primary fistulae occur most frequently between the aorta and esophagus or duodenum. Primary iliac-enteric fistulae are rare, occurring in about 0.07% of the general population.1 However, this is a possible cause of brisk lower gastrointestinal bleeding and should be considered in the differential of these patients. A small case series describing six patients with primary aorto/iliac-enteric fistulae found the overall 30-day mortality rate to be 50%.2 If there is suspicion for this, an enhanced CT scan should be obtained immediately as proceeding with endoscopic evaluation will only delay definitive therapy.FigureFigureFigure

Emergent endovascular repair of a ruptured giant internal iliac artery aneurysm using an inverted iliac limb endograft

An 88-year-old man with hypertension, coronary artery disease, morbid obesity, and a remote history of a prior open abdominal aortic aneurysm repair with an infrarenal tube graft developed acute abdominal pain accompanied by dizziness after a bowel movement. He was taken to an outside hospital, where a computed tomography angiogram was obtained. This demonstrated a right internal iliac artery aneurysm measuring 11.4 cm with a large retroperitoneal rupture (A). He was transferred emergently to our tertiary referral center for repair. On arrival, he was pale and hypotensive. He initially refused intervention but subsequently agreed to an attempt at endovascular repair. Retrograde right common femoral access was obtained, and angiography demonstrated the large right internal iliac artery aneurysm. The right common iliac artery measured 22.8 mm, and the right external iliac artery measured 14.4 mm. Repair with a bifurcated endovascular aneurysm repair device was considered, although this would have been more time-consuming in the setting of hemorrhagic shock. A 27- × 16-mm Gore Contralateral Leg Endoprosthesis (W. L. Gore & Associates, Flagstaff, Ariz) provided excellent size match, but this device is designed for “large side down” deployment. Therefore, we proceeded to implant the device using the technique previously described by van der Steenhoven et al.1van der Steenhoven T.J. Heyligers J.M. Tielliu I.F. Zeebregts C.J. The upside down Gore Excluder contralateral leg without extracorporeal predeployment for aortic or iliac aneurysm exclusion.J Vasc Surg. 2011; 53: 1738-1741Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar Briefly, this involves removing the device from its delivery shaft, reversing it, placing it within a sheath, and using a modified sheath dilator as a pushing device to position and deploy the limb with a “pin and pull” maneuver. This allowed rapid exclusion of the ruptured internal iliac artery aneurysm (B). The patient did well postoperatively and was discharged after a short stay. This case illustrates that a knowledge of alternative techniques for endovascular device implantation can allow expeditious and effective emergency interventions. It also serves as a reminder that aneurysmal disease can be systemic and progressive and that repair of an infrarenal aneurysm does not protect against late rupture of other abnormal vessels. The patient's wife, who functioned as his durable power of attorney, provided consent for publication of this case report and associated images.

Hybrid Retrograde Endovascular Repair of a Rapidly Expanding Chronic SMA Dissection

A 59-year-old man with a 7-cm superior mesenteric artery (SMA) aneurysm had expanded 2 cm in the past 4 months. He presented 7 years after being lost to follow-up in the early postoperative period after thoracic endovascular aortic repair for type B dissection with dilated chronic aortic and aortic branch dissections: a 12-cm type 3 thoracoabdominal aortic aneurysm, a 59-cm SMA aneurysm, and 4-cm common and internal iliac artery aneurysms. As the patient underwent and recovered from a staged, multimodal, thoracoabdominal aortic and iliac artery repair, the SMA aneurysmal dilation rapidly progressed. Given the previous thoracoabdominal aortic surgery as well as an inflamed, large, residual aortic aneurysm sac and inflamed surrounding tissue, including the large SMA aneurysm itself, a hybrid retrograde endovascular repair was used. This consisted of laparotomy, and SMA true lumen branch exploration with open and retrograde placement of endografts from the SMA thoracoabdominal branch graft repair to the true lumen of the native SMA, followed by patch angioplasty and SMA false lumen embolization. The patient recovered well and was discharged to home after a 1-week hospital admission. Resultant, extensive, aneurysmal dilations may be safely repaired in a multistage, multimodal fashion to use the advantages of a variety of approaches—endovascular, open, and hybrid—while modifying technical challenges and overall risk.

Pelvic artery aneurysm screening provides value in patients with thoracic aortic aneurysms.

Approximately ¼ of patients with thoracic aortic aneurysms (TAAs) have concomitant abdominal aortic aneurysms (AAAs), thereby justifying the addition of an abdominal CT scan to a chest CT scan in patients with a newly diagnosed or suspected TAA. However, the prevalence of pelvic artery aneurysms (PAAs) in these patients is unknown. The purpose of this study was to determine the prevalence of PAAs in patients with TAAs and to assess what patient specific factors were associated with PAAs, thereby providing insight into the usefulness of pelvic imaging in TAA patients. Consecutive non-operated patients seen in Cardiac Surgery clinic between 2008 and 2013 with a TAA and a CT scan of the chest/abdomen/pelvis were included. Scans of 371 patients were evaluated for PAAs using threshold diameters of 20 and 15mm for common iliac artery aneurysms (CIAs) and internal iliac artery aneurysms (IIAs), respectively, on 3D analysis. The prevalence of PAAs was determined and multiple logistic regression was used to identify associated risk factors. 41 of 371 (11.1%) patients with a TAA had at least one PAA. Factors showing positive associations with PAAs included increased age (p = 0.0004), male gender (p = 0.0007), descending TAA location (p = 0.0024) and presence of an AAA (p < 0.0001). The results of our study suggest that the addition of pelvic imaging for PAA screening in patients undergoing an initial CT scan of the chest and abdomen for a TAA is valuable, particularly in patients with the following demographics: age ≥65, male gender, descending TAA location, and/or known AAA.

Aortic aneurysm endovascular treatment with the parallel graft technique from the aortic arch to the iliac axis.

The chimney technique has been developed for the treatment of complex aortic aneurysms. We analyzed the midterm to long-term outcomes of this approach from a single-center experience. From October 2008 to July 2016, 58 patients underwent endovascular aortic aneurysm repair using the chimney technique. Indications for treatment were thoracic aortic aneurysm (TAA) (N.=11), thoracoabdominal aortic aneurysm (TAAA) (N.=2), pararenal aortic aneurysm (PAAA) (N.=15), aortoiliac/isolated hypogastric artery aneurysm (N.=25), type I endoleak after previous TEVAR/EVAR (N.=4), proximal pseudoaneurysm after AAA open repair (N.=1). Elective (82.8%) and emergent (17.2%) procedures were included. The immediate technical success was 100%. Single, double and triple chimneys were performed in 46, 10, and two patients, respectively. Overall, 61 target vessels (three left common carotid arteries, eight left subclavian arteries, three celiac trunks, three superior mesenteric arteries, 19 renal arteries and 25 hypogastric arteries) were involved. Postoperative mortality was 0. No neurologic complications were registered. Primary patency rate of the chimney stent/stent graft was 98.3%. Low-flow type I endoleak was observed in four patients (6.9%). Postoperative chimney graft re-intervention rate was 1.7%. The median follow-up was 32±20 months (range 3-96 months). Overall estimated survival at 12, 50, and 80 months was 100%, 89% and 44%, respectively. Estimated freedom from endoleak at 1, 12, 24, and 36 months was 96.5%, 95%, 95%, and 93%, respectively. One hypogastric artery stent-graft occluded at the 3rd month of follow-up. No reintervention was performed. Our experience with the chimney technique for aortic aneurysms from the aortic arch to the iliac axis shows promising and durable mid- and long-term results. Endograft oversizing, associated with the chimney graft diameter and length choice remain fundamental to reduce the risk of the most frequent procedure complications: type I endoleak and CG occlusion. The wider use of this technique should be justified in patients considered at high risk for open repair and/or not suitable for the custom-made branched/fenestrated endografts.

Clinical outcomes of hypogastric artery occlusion for endovascular aortic aneurysm repair

Purpose: To determine the midterm outcomes of internal iliac artery (IIA) coverage by a stent-graft in endovascular aortic aneurysm repair (EVAR) under specific anatomic and technical circumstances.Material and methods: From January 2003 until January 2014, 57 patients with aortoiliac aneurysms, including 20 with 24 IIA aneurysms (IIAAs), underwent EVAR with IIA coverage. IIAA diameter change or IIA thrombosis, buttock claudication, type II endoleak, and secondary interventions related to the IIA were studied.Results: Twenty-five of the 37 patients without IIAA were embolized prior to stent-graft placement, all unilateral, and in 12, the IAA orifice was only overstented. Buttock claudication occurred in only nine (20%) of the embolization patients (9/49 IIA’s) (p = .14), while one IIA-related type II endoleak, occurred in the nonembolization group (p = .16). In patients with IIAA(s), the aneurysm diameter decreased in 16 cases (67%). Buttock claudication occurred in 75% of bilateral, and in 14.6% of unilateral embolizations (p = .046).Conclusions: Carefully selected patients with aortoiliac aneurysm without IIAA may safely undergo hypogastric artery overstenting without preemptive embolization during EVAR. IIA embolization is associated with buttock claudication and should be avoided if possible. Otherwise, at least one IIA should be preserved.

Erratum to: Non-surgical Management of a Mycotic Internal Iliac Artery Aneurysm in a Neonate: Case Report and Review of the Literature.

Erratum to: Non-surgical Management of a Mycotic Internal Iliac Artery Aneurysm in a Neonate: Case Report and Review of the Literature.

Midterm results of internal iliac artery aneurysm embolization.

We describe the immediate and midterm results of endovascular treatment of isolated internal iliac artery aneurysms (IIAA). This was a retrospective single center study. From 2005 to 2014, data from 20 consecutive patients who had an embolisation for an isolated atherosclerotic internal iliac artery aneurysm underwent an endovascular treatment. We retrospectively evaluated the technical aspects and outcomes. The mean aneurysm diameter was 42mm (range 30-97mm). No perioperative deaths or treatment failures occurred. No endoleaks or secondary aneurysm ruptures were observed during the follow-up. Three patients experienced disabling buttock claudication, which was spontaneously remissive in two cases. No relationship was found between buttock claudication and the patency of the contralateral internal iliac artery and the deep femoral artery. Six patients (30%) died during follow-up. Among these, three patients died due to cardiovascular events. The mean follow-up interval was 24 months (range 6-96 months). The endovascular treatment of isolated internal iliac artery aneurysm is safe in the short-term and could prevent secondary aneurysm rupture at midterm.

A Rare Presentation of an Isolated Internal Iliac Artery Aneurysm: Report of a Case and Literature Review

Isolated internal iliac artery aneurysms (IIIAAs) are extremely rare. We present the case of a 75-year-old white Caucasian male patient admitted for right lower limb deep venous thrombosis and low-risk pulmonary embolism due to the compression of the external iliac vein from an IIIAA. A review of the literature was also performed to identify the epidemiologic, clinical characteristics and diagnostic and operative strategies of this disease. At present, a recommendation for the best operative strategy in the presence of an IIIAA is difficult. Our analysis demonstrated controversial results, but we are confident to recommend the endovascular treatment in an elective setting.

Resultados a corto y medio plazo en el tratamiento endovascular de aneurismas aortoiliacos o iliacos mediante el uso del dispositivo de rama iliaca

ObjectiveAn iliac branch device (IBD) is used as a technique to avoid or minimise the complications associated with the occlusion of the hypogastric artery (HA). The purpose of this paper is to analyse the short and medium-term outcomes with the use of an IBD in our centre. Material and methodsA descriptive study that included 28 HA of 14 patients with an aorto-iliac aneurysm treated with an IBD between 2011 and 2015. There were 14 (100%) bilateral iliac artery aneurysms, 11 (78.6%) associated with an aortic aneurysm, and 4 (14.3%) with HA aneurysm. Of the 28 HA, 19 (67.8%) where treated with an IBD (5 bilateral), 4 (14.3%) were covered with the endoprosthesis, 2 (7.1%) were embolised, 2 were not treated, and one was treated with a covered stent graft in order to treat the hypogastric aneurysm. In all of the cases one HA was patent. An analysis is presented of the mortality, patency, endoleaks, buttock claudication, erectile dysfunction, and pelvic ischaemia. CT angiogram and doppler ultrasound were used in the follow-up. ResultsAll (100%) the patients were male, with a mean age of 74.6±13.6 years. Patency at one month was 94.7%, 80% at one year, and 77.7% at 2 years. There was 0% mortality, endoleaks, buttock claudication of the side treated, erectile dysfunction, and pelvic ischaemia. There were 2 cases of contralateral buttock claudication, one of contralateral iliac artery thrombosis, resolved through a femoro-femoral bypass, and one case of intra-operative IBD thrombosis that was treated favourably with thrombolysis. Mean follow-up was 23.3 months (range 1-67) with 2 losses in the study. ConclusionIn our experience, IBD is a safe and efficient technique, with few complications and good patency. Longer follow-up studies should be performed.

Non-surgical Management of a Mycotic Internal Iliac Artery Aneurysm in a Neonate: Case Report and Review of the Literature.

We report a unique case of neonatal mycotic internal iliac artery aneurysm managed non-operatively. The child had multifocal osteomyelitis and no history of umbilical artery catheterisation. The aneurysm was regularly scanned and monitored until its obliteration by thrombus 17days after initial detection. Contingency plans for either interventional radiological coiling or open surgical repair were in place had the aneurysm grown or the child deteriorated.

Iliac Artery Aneurysms

The terminal abdominal aorta divides into the common iliac arteries at the L4 level. At the level of the sacrum, the common iliac arteries divide into the external iliac arteries and internal iliac (hypogastric) arteries. This review covers aneurysms of the iliac arteries, with discussion of the anatomy, clinical evaluation, investigative studies, management, and follow-up imaging. Figures show common presenting configurations of iliac artery aneurysms, examples of open repair techniques for common iliac artery aneurysms, example of internal iliac artery revascularization in the setting of common iliac artery aneurysm repair, examples of endovascular repair techniques for common iliac artery aneurysms, complex hybrid repair of multiple iliac aneurysms, examples of open repair techniques for internal iliac artery aneurysms, and examples of endovascular repair for internal iliac artery aneurysms. Tables list normal diameters reported by the Subcommittee on Reporting Standards for Arterial Aneurysms, rate of growth of aneurysms based on size at presentation, presenting signs and symptoms of iliac artery aneurysm, and location, rupture, and mortality reported in the literature. This review contains 7 highly rendered figures, 4 tables, and 91 references Keywords: Iliac artery aneurysms; IAA; Common iliac artery aneurysms; Internal iliac artery aneurysm; IIAA; External iliac artery aneurysm

感染性心内膜炎における総腸骨動脈塞栓除去術後に発生した感染性内腸骨動脈瘤の1例

症例は23歳女性で，右総腸骨動脈塞栓を伴う感染性心内膜炎に対してFogartyカテーテルによる経大腿動脈塞栓除去術および僧帽弁置換術が行われた．術後9日目のCT検査で右内腸骨動脈閉塞が認められ，塞栓除去術の際に右総腸骨動脈の塞栓子の一部が右内腸骨動脈へ迷入したことが原因と考えられた．その後，人工弁周囲逆流が生じたため，術後16日目に再僧帽弁置換術が行われた．さらに右内腸骨動脈塞栓の診断後約2週の経過で塞栓部に動脈瘤を形成した．最終的に動脈瘤切除術を必要としたが術後経過は良好であった．本症例はseptic embolismから感染性動脈瘤に至る過程を画像診断でとらえた稀な症例と思われた．また，感染性心内膜炎におけるseptic embolismに対して，Fogartyカテーテルを用いた塞栓除去術を行う際には，分枝への塞栓子迷入に注意が必要である．

Complications of Endovascular Management of Isolated Internal Iliac Artery Aneurysm

The isolated internal iliac artery aneurysm is rare, but can be fatal if non-diagnosed. Endovascular treatment of these aneurysms, ideally with exclusion of the sac from antegrade and retrograde perfusion, provides a minimally invasive alternative that avoids the direct operative morbidity. We present a case of a patient treated with embolization with coils of an aneurysm of the left internal iliac artery. Then, 6 months after the procedure, the patient suffered from recurrence of abdominal pain. CT scan confirmed patency of the aneurysmal sac. Therefore, he underwent second endovascular exclusion by an external iliac artery stentgraft by ipsilateral femoral access. In the angiography post-implantation, an endoleak was diagnosed. So, a second distal stentgraft was implanted in the external iliac artery. After implantation, a total exclusion of the aneurysm was obtained. The follow-up is now 3 months. The patient is asymptomatic.

A Surgical Case of Internal Iliac Artery Aneurysm Causing Sciatica

A Surgical Case of Internal Iliac Artery Aneurysm Causing Sciatica

Inferior Mesentery Artery and Internal Iliac Artery Preservation with Covered Self-Expanding Stents during Endovascular Aneurysm Repair

We report an endovascular aneurysm repair in a patient with isolated bilateral common iliac artery aneurysms, a prominent inferior mesentery artery (IMA), and bilateral proximal internal iliac artery (IIA) aneurysms using covered self-expanding stents to preserve the IMA and bilateral internal iliac arteries. A follow-up computed tomography angiography was obtained at 1 month. Pelvic circulation was well preserved without bowel ischemia. IMA and bilateral IIA preservation with covered self-expanding stents during endovascular aneurysm repair is a safe and effective method.

Few internal iliac artery aneurysms rupture under 4 cm

ObjectiveThis study investigated the diameter of internal iliac artery (IIA) aneurysms (IIAAs) at the time of rupture to evaluate whether the current threshold diameter for elective repair of 3 cm is reasonable. The prevalence of concomitant aneurysms and results of surgical treatment were also investigated. MethodsThis was a retrospective analysis of patients with ruptured IIAA from seven countries. The patients were collected from vascular registries and patient records of 28 vascular centers. Computed tomography images taken at the time of rupture were analyzed, and maximal diameters of the ruptured IIA and other aortoiliac arteries were measured. Data on the type of surgical treatment, mortality at 30 days, and follow-up were collected. ResultsSixty-three patients (55 men and 8 women) were identified, operated on from 2002 to 2015. The patients were a mean age of 76.6 years (standard deviation, 9.0; range 48-93 years). A concomitant common iliac artery aneurysm was present in 65.0%, 41.7% had a concomitant abdominal aortic aneurysm, and 36.7% had both. IIAA was isolated in 30.0%. The mean maximal diameter of the ruptured artery was 68.4 mm (standard deviation, 20.5 mm; median, 67.0 mm; range, 25-116 mm). One rupture occurred at <3 cm and four at <4 cm (6.3% of all ruptures). All patients were treated, 73.0% by open repair and 27.0% by endovascular repair. The 30-day mortality was 12.7%. Median follow-up was 18.3 months (interquartile range, 2.0-48.3 months). The 1-year Kaplan-Meier estimate for survival was 74.5% (standard error, 5.7%). ConclusionsIIAA is an uncommon condition and mostly coexists with other aortoiliac aneurysms. Follow-up until a diameter of 4 cm seems justified, at least in elderly men, although lack of surveillance data precludes firm conclusions. The mortality was low compared with previously published figures and lower than mortality in patients with ruptured abdominal aortic aneurysm.