Ruptured iliac aneurysms

Isolated iliac artery aneurysms

OBJECTIVE

To assess our experience with isolated iliac artery aneurysms and to assess the blood transfusion requirement in patients undergoing surgery for iliac artery aneurysms.

MATERIAL AND METHODS

The case records of 12 patients who underwent 12 arterial reconstructive procedures for isolated iliac aneurysms from January 1989 to December 1995 were identified from our prospective vascular database and reviewed. Only patients with aneurysms limited to the common, external, or internal iliac arteries were included.

RESULTS

Eleven patients had symptoms and rupture occurred in five patients. Aneurysmorrhaphy with graft interposition was the most common procedure. There was no perioperative mortality. The median transfusion requirement was 11 units per operation (range 1-30 units). The median intraoperative blood loss was 4700 ml (range < 500-13,000 ml).

CONCLUSIONS

Isolated iliac aneurysm is a dangerous condition. A low perioperative mortality is possible only if large volumes of blood are available.

An unusual but important cause of sciatica

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Isolated iliac artery aneurysms

Clinical and diagnostic data were collected from 22 men with iliac artery aneurysms treated surgically over a period of 22 years. Their ages ranged from 47 to 80 years (mean 64.0). Eight patients had multiple aneurysms. Thirty isolated iliac artery aneurysms were detected, 20 aneurysms (66.6%) located on the right and 10 (33.3%) on the left side. Twenty-six aneurysms were found in the common iliac artery (86.6%). Fifteen patients were symptomatic (68.2%); rupture occurred in five patients (22.7%), three of whom were initially asymptomatic. Thirteen of 17 patients whose aneurysms did not rupture had a palpable mass (76.4%), and three had bruits in the area of the aneurysm. All 22 patients were subjected to operative procedures. Seventeen patients operated upon electively survived, whereas only three patients who were operated upon after rupture survived. Graft interposition was the most common procedure. All 20 patients who survived after the operation were followed. Two died of myocardial infarction three and five years later, one of cancer six years later, and one of an unknown cause eight years after operation. Iliac artery aneurysms are extremely rare; their diagnosis is very difficult. The mortality rate is two times higher than in aortic aneurysms, once the diagnosis has been established. Therefore elective resection and arterial reconstruction are recommended.

Arterial fibromuscular dysplasia

Fibromuscular dysplasia is a nonatherosclerotic, noninflammatory vascular disease that involves primarily the renal and internal carotid arteries and less often the vertebral, iliac, subclavian, and visceral arteries. Although its pathogenesis is not completely understood, humoral, mechanical, and genetic factors as well as mural ischemia may play a role. The natural history is relatively benign, with progression occurring in only a minority of the patients. Typical clinical manifestations are renovascular hypertension, stroke, subarachnoid hemorrhage, abdominal angina, or claudication of the legs or arms. In patients with symptoms, percutaneous transluminal angioplasty has emerged as the treatment of choice in most involved vascular beds.

Ureteric obstruction of solitary kidneys by aneurysms of the iliac artery

Two rare cases are reported, both known to have solitary kidneys, that had ureteric obstruction caused by iliac artery aneurysms. Iliac aneurysms have a high mortality and may present to the urologist as an uncommon cause of ureteric obstruction. When the ureter of a solitary kidney is obstructed it is recommended that both ureterolysis and a temporary proximal diversion be performed. A common iliac aneurysm should be excised and grafted where possible; an internal iliac aneurysm is best treated by simple ligation or partial excision only.

Isolated internal iliac artery aneurysms and their urological manifestations

Three cases of isolated hypogastric artery aneurysms are presented, making the total reported 27. Of these 3 patients 2 had urinary tract involvement. The association of hypogastric artery aneurysms and the urinary tract occurs in 54% of such patients. Of all patients 42% had ureteral involvement and a similar percentage presented with urologic symptoms. In 38% of the patients bladder pathology was associated with the aneurysm. Although hypogastric artery aneurysms are uncommon their timely recognition is important to the urologist.

Leaking left hypogastric artery aneurysm causing bilateral ureteric obstruction

A pelvic hematoma arising from a leaking left hypogastric aneurysm resulted in the acute onset of bilateral flank pain and bilateral ureteral obstruction in a sixty-four-year-old black man. Intravenous pyelogram revealed a pelvic hematoma with narrowing of both lower ureters, hydroureteronephrosis, and anterior bladder displacement. Cystoscopy revealed anterior displacement of the bladder base which appeared pulsatile. Arteriography confirmed the leaking hypogastric aneurysm, and successful surgical ligation was performed.