Ruptured aneurysm of the internal iliac artery

Spontaneous Thrombosis of an Isolated Internal Iliac Artery Aneurysm

BACKGROUND

Isolated internal iliac artery aneurysms (IIAAs) are uncommon but potentially morbid lesions that are a challenge to monitor and treat. However, given the small numbers of reported cases and high rates of incidentally discovered lesions, the natural history of isolated IIAAs is not well characterized. This case describes an atypical and previously unreported spontaneous thrombosis of an isolated IIAA, a lesion typically thought to progressively enlarge and rupture.

METHODS

Medical records and imaging studies were retrospectively reviewed with the approval of our Institutional Review Board. A single patient underwent fluoroscopic angiography followed by computed tomography (CT) angiography, with no subsequent operative intervention.

RESULTS

An isolated 5.5 cm left IIAA was discovered incidentally on CT scan and subsequently seen with fluoroscopic pelvic angiography. Three weeks following initial angiography, repeat pelvic angiography and CT scan demonstrated spontaneous thrombosis of the aneurysm.

CONCLUSIONS

Isolated IIAAs are conditions for which the natural history remains uncertain despite their potential risk for rupture and mortality. Spontaneous thrombosis of these lesions is possible, suggesting that the natural history as previously described warrants further consideration.

Internal iliac artery pseudoaneurysm: a rare presentation with foot drop and sciatica

Internal iliac artery pseudoaneurysm is rare in incidence with most of them being asymptomatic. It may present with neurologic symptoms like paraesthesia, sciatica, weakness of lower limb, foot drop, etc., and in such scenario, high index of suspicion is needed to diagnose. Early intervention should be the strategy in all symptomatic and in asymptomatic cases with size > 4 cm diameter. We present a case of a 40-year-old female with left internal iliac artery pseudoaneurysm who presented with foot drop and sciatica, which is a very rare presentation, and was managed successfully by resection and interposition grafting.

Spontaneous Rupture of Internal Iliac Artery in Pregnancy: Case Report

SUMMARY – Rupture of the internal iliac artery is a rare complication in pregnancy that is associated with maternal and fetal morbidity and mortality. We present a case of a 30-year-old primipara admitted to our department in 39^th week of gestation after sudden onset of intense abdominal pain. On admission, the patient was pale, tachycardiac, but with normal blood pressure and afebrile. Symptoms of acute abdomen were clear and surgery was indicated. Diagnosis was confirmed during cesarean section. Enlarged gravid uterus compressed the ruptured artery and prevented heavier bleeding. Acute bleeding due to arterial rupture causes severe symptoms, predominantly abdominal pain. Changes in blood count become significant some time after the onset of rupture. As the gravid uterus compressed the arterial rupture, preoperative bleeding was by far less abundant than the bleeding after the baby had been delivered and the size of the uterus decreased. Any cause of acute abdomen during pregnancy (abruption of the placenta, spleen rupture, visceral artery thrombosis) requires urgent surgical treatment, as well as intraoperative and postoperative intensive treatment. Rupture of the internal iliac artery is a rare complication in pregnancy, but has to be considered as a differential diagnosis of abdominal pain.

The 100-year evolution of the isolated internal iliac artery aneurysm

BACKGROUND

Isolated internal iliac artery aneurysms (IIIAA) are a rare form of aneurysm. The incidence increases with age, and the prevalence is higher in men. The clinical presentation can vary, and standard treatment protocols are not established. The first case of an IIIAA was described more than 100 years ago. The purpose of the study is to summarize the various clinical presentations and treatment options that have been reported in the literature in the past 100 years.

METHODS

Literature about IIIAA was reviewed using the electronic databank PubMed. All case reports and case series were analyzed, and we included our own data with 2 case reports.

RESULTS

Over time, IIIAA diagnosis increasingly resulted from asymptomatic incidental findings on radiologic studies. Various clinical presentations included abdominal pain, back pain, rectal bleeding, hydronephrosis with renal failure, hematuria, and free rupture with shock. Rupture has a mortality rate of 53%. IIIAAs were more common on the left (61.8% left, 27.3% right, 10.9% bilateral). Treatments include open surgical repair and endovascular repair using a variety of methods. One article reported a hybrid method using both endovascular and open surgical technique.

CONCLUSIONS

Since its first description 100 years ago, we have gained knowledge about the natural history of IIIAA. Multiple treatment options have been described, but long-term outcome needs further investigation.

Aneurisma de artéria ilíaca interna roto: relato de caso

Aneurismas isolados da artéria ilíaca interna são raros, acometem 0,1% da população e correspondem a 1% dos aneurismas aorto-ilíacos. Na maioria das vezes, os pacientes são assintomáticos, mas podem apresentar dor abdominal, massa pulsátil no hipogástrio ou na fossa ilíaca, sintomas compressivos urinários, gastrointestinais ou neurológicos. Podem ocasionar quadro de abdome agudo, principalmente quando há ruptura. O diagnóstico precoce dos aneurismas isolados de artéria ilíaca interna é incomum, sendo identificados quando mais volumosos ou rotos, o que aumenta significativamente sua morbimortalidade e torna seu prognóstico mais reservado. Dessa forma, representam um desafio terapêutico. A ligadura cirúrgica tem sido o tratamento mais comum, entretanto a cirurgia endovascular tem mostrado bons resultados, inclusive nos aneurismas rotos. É relatado caso de aneurisma de artéria ilíaca interna isolado roto diagnosticado durante laparotomia para abordagem de abdome agudo.

The Isolated Internal Iliac Artery Aneurysm—A Review

BACKGROUND

The isolated internal iliac artery aneurysm (IIIAA) is rare but rupture has a high mortality rate. This paper reviews the available literature regarding the epidemiology, aetiology, natural history, diagnosis and management with a focus on aneurysms of atherosclerotic origin.

METHODS

A literature search was performed using internet databases PubMed, Medline and Medscape followed by manual cross referencing of relevant articles. Data were retrieved from the papers, tabulated and analysed to form a review of atherosclerotic IIIAA.

RESULTS

Three hundred and seventy-two papers were found relating to internal iliac artery aneurysms in general and 82 were directly relevant to this paper, reporting 94 cases of atherosclerotic IIIAA. For atherosclerotic aneurysms, the median (range) age was 71.9 (47-89) years and 95% were male. The natural history is unclear but is probably one of increasing size, with corresponding increased risk of rupture. Presentation was with rupture in 40%, leading to rapid death if untreated. The death rate in the group as a whole was 31%. The median (range) size of aneurysms at diagnosis was 7.7 (2-13) cm and death was significantly associated with rupture (Spearman correlation coefficient r=0.327, p=0.007). Symptoms included abdominal pain (31.7%), urological symptoms (28.3%), neurological symptoms (18.3%), groin pain (11.7%), hip or buttock pain (8.3%) and gastrointestinal symptoms (8.3%). Diagnosis may also be coincidental as a result of investigation for other conditions. Of particular use in diagnosis and assessment are ultrasound, computerised tomography and magnetic resonance angiography. Surgical treatment is difficult but can be achieved by ligation, excision or endoanneurysmorrhaphy. More recently, radiological treatments include coil embolisation and endoluminal stenting (often in combination) with the established advantages of endovascular repair have yielded promising short term results, although long term follow-up is required to assess complications and the durability of the devices.

CONCLUSIONS

Atherosclerotic IIIAA is a rare condition and if undiagnosed is often fatal. Early diagnosis and treatment may reduce morbidity and mortality particularly with the advent of endovascular techniques.