Signs of impending rupture in abdominal aortic and iliac artery aneurysms by computed tomography: Outcomes in 41 patients

OBJECTIVES

This study aimed to determine the prevalence of signs of impending rupture (SIR) in asymptomatic patients with abdominal aortic and iliac artery aneurysms, and to evaluate whether these signs were associated with rupture in asymptomatic patients.

METHODS

This was a retrospective study of patients with abdominal aortic and iliac artery aneurysms identified on computed tomography (CT) over a 10-year period in a single center. The CT scans were reviewed by two reviewers, and patients with SIR were assigned to one of three groups: (1) early symptomatic (ES), (2) late symptomatic (LS), and (3) always asymptomatic (AA). The four main SIR described in the literature were investigated: 1) crescent sign, 2) focal wall discontinuity of circumferential calcifications, 3) aortic bulges or blebs, and 4) aortic draping.

RESULTS

From a total of 759 aortic and iliac aneurysm reports on 2226 CT scans, we identified 41 patients with at least one SIR, and a prevalence of 4.14% in asymptomatic patients. Focal wall discontinuity of circumferential calcifications was the most common sign, and it was present in 46.3% of these patients (19/41); among these, 26 were repaired (ES: 9, LS: 2, AA: 15). Eleven asymptomatic patients underwent follow-up CT. The aneurysm increased in size in 6 of the 11 (54.5%) patients, and three ruptured (all with discontinuity of calcifications), one of which had no increase in diameter.

CONCLUSIONS

The presence of focal wall discontinuity of circumferential calcifications was the most common SIR. There was a prevalence of all signs in less than 5% of asymptomatic patients. In unrepaired patients, the signs could be observed on follow-up CT scans with an increase in aneurysm size, indicating that the presence of SIR alone in the absence of other clinical factors or aneurysm characteristics is an insufficient indication for surgery.

Editor's Choice - Nationwide Analysis of Patients Undergoing Iliac Artery Aneurysm Repair in the Netherlands

OBJECTIVE

The new 2019 guideline of the European Society for Vascular Surgery (ESVS) recommends consideration for elective iliac artery aneurysm (eIAA) repair when the iliac diameter exceeds 3.5 cm, as opposed to 3.0 cm previously. The current study assessed diameters at time of eIAA repair and ruptured IAA (rIAA) repair and compared clinical outcomes after open surgical repair (OSR) and endovascular aneurysm repair (EVAR).

METHODS

This retrospective observational study used the nationwide Dutch Surgical Aneurysm Audit (DSAA) registry that includes all patients who undergo aorto-iliac aneurysm repair in the Netherlands. All patients who underwent primary IAA repair between 1 January 2014 and 1 January 2018 were included. Diameters at time of eIAA and rIAA repair were compared in a descriptive fashion. The anatomical location of the IAA was not registered in the registry. Patient characteristics and outcomes of OSR and EVAR were compared with appropriate statistical tests.

RESULTS

The DSAA registry comprised 974 patients who underwent IAA repair. A total of 851 patients were included after exclusion of patients undergoing revision surgery and patients with missing essential variables. eIAA repair was carried out in 713 patients, rIAA repair in 102, and symptomatic IAA repair in 36. OSR was performed in 205, EVAR in 618, and hybrid repairs and conversions in 28. The median maximum IAA diameter at the time of eIAA and rIAA repair was 43 (IQR 38-50) mm and 68 (IQR 58-85) mm, respectively. Mortality was 1.3% (95% CI 0.7-2.4) after eIAA repair and 25.5% (95% CI 18.0-34.7) after rIAA repair. Mortality was not significantly different between the OSR and EVAR subgroups. Elective OSR was associated with significantly more complications than EVAR (intra-operative: 9.8% vs. 3.6%, post-operative: 34.0% vs. 13.8%, respectively).

CONCLUSION

In the Netherlands, most eIAA repairs are performed at diameters larger than recommended by the ESVS guideline. These findings appear to support the recent increase in the threshold diameter for eIAA repair.

Prevalence of abdominal aortic aneurysm and associated lower extremity artery aneurysm in men hospitalized for suspected or known cardiopulmonary disease

BACKGROUND

AAA is a disease affecting predominantly male patients ≥65 years and its dreaded complications such as rupture led to population-based screening programs as preventive measure. Nonetheless, the supposed prevalence may have been overestimated, so that targeted screening of high risk populations may be more effective. This study was performed to evaluate the prevalence of abdominal aortic aneurysm (AAA) of an inpatient high-risk cohort and to estimate the co-prevalence of lower extremity arterial aneurysms.

METHODS

Participants: 566 male inpatients, ≥ 65 years of age, hospitalized for suspected or known cardiopulmonary disease. Primary and secondary outcome measures: Maximal infrarenal aortic diameters using abdominal ultrasound (leading edge to leading edge method). Upon detection of an AAA (diameter ≥ 30 mm), the lower extremity arteries were examined with regard to associated aneurysms.

RESULTS

In 40 of 566 patients (7.1%) AAAs were detectable. Fourteen patients (2.5%) had a first diagnosis of AAA, none of which was large (> 55 mm), the remaining 26 patients were either already diagnosed (14 patients, 2.5%) or previously repaired (12 patients, 2.1%). The three most common main diagnoses at discharge were acute coronary syndrome (43.3%), congestive heart failure (32.2%), and chronic obstructive pulmonary disease (12%). The cohort showed a distinct cardiovascular risk profile comprising arterial hypertension (82.9%), diabetes mellitus (44.4%), and a history of smoking (57.6%). In multivariate analysis, three-vessel coronary artery disease (Odds ratio (OR): 4.5, 95% confidence interval (CI): 2.3-8.9, p <  0.0001) and history of smoking (OR: 3.7, CI: 1.6-8.6, p <  0.01) were positively associated with AAA, while diabetes mellitus (OR: 0.5, CI: 0.2-0.9, p = 0.0295) showed a negative association with AAA. Among the subjects with AAA, we found two large iliac and two large popliteal aneurysms.

CONCLUSION

Ultrasound screening in male inpatients, hospitalized for suspected or known cardiopulmonary disease, revealed a high AAA prevalence in comparison to the present epidemiological screening programs. There was a moderate proportion of newly-screen detected AAA and additional screening of the lower extremity arteries yielded some associated aneurysms with indication for possible intervention.

Multiple giant coronary artery aneurysms: a case report

BACKGROUND

Coronary artery aneurysm is defined as a localized area of dilatation exceeding the diameter of the adjacent normal arterial segment by 50%. Giant aneurysms are those aneurysms that measure greater than 2cm in diameter. There have been many pathologic diseases, including atherosclerosis, that have been implicated in the development of coronary artery aneurysms.

MATERIALS AND METHODS

We report a case of a 61-year-old African American male with multiple comorbidities including hypertension, congestive heart failure, abdominal aortic aneurysm, and bilateral iliac aneurysms, who was admitted to our hospital with exacerbation of congestive heart failure. Less than 2weeks after admission, the patient suffered cardiac arrest while receiving dialysis and was unresponsive to resuscitative measures.

FINDINGS

Autopsy was performed and revealed significant cardiomyopathy and giant coronary artery aneurysms involving the left anterior descending, left circumflex, and right coronary arteries. Both ventricles showed hypertrophy and dilation with multifocal areas of chronic myocardial scarring.

CONCLUSIONS

Coronary artery aneurysms and giant coronary artery aneurysms are an uncommon. As there are few reported cases in the literature, the cause, detection, and treatment of this disease are still largely unknown.

Family history of aortic disease predicts disease patterns and progression and is a significant influence on management strategies for patients and their relatives

BACKGROUND

While a positive family history (FH) is a known risk factor for developing an aneurysm, its association with the extent of disease has not been established. We evaluated the influence of a FH of aortic disease with respect to the pattern and distribution of aortic aneurysms in a given patient.

METHODS AND RESULTS

From November 1999 to November 2011, 1263 patients were enrolled in physician-sponsored endovascular device trials to treat aortic aneurysms. Of the 555 patients who were alive and returning for follow-up, we obtained 426 (77%) family histories. Three-dimensional imaging studies were used to identify the presence of aneurysms; 36% (155/426) of patients had a FH of aortic aneurysms and 5% (21/155) had isolated intracranial aneurysms. A logistic regression model was used to compare aortic morphology between patients with a positive or negative FH for aneurysms. Patients with a positive FH of aortic aneurysms were younger at their initial aneurysm (63 vs 70 years; P < .0001), more frequently had proximal aortic involvement (root: odds ratio [OR], 5.4; P < .0001; ascending: OR, 2.9; P < .001; thoracic: OR, 2.2; P = .01) with over 50% of FH patients ultimately developing suprarenal aortic involvement (P = .0001) and had a greater incidence of bilateral iliac artery aneurysm (OR, 1.8; P = .03).

CONCLUSIONS

FH is an important tool that provides insight into the expected behavior of the untreated aorta and has significant implications for the development of treatment strategies. These findings should be used to guide patient's management with regard to treatment, follow-up paradigms, genetic testing, and screening of other family members.

Trends in prevalence of fatal surgical diseases at forensic autopsy

BACKGROUND

In 1992, there were major changes in Swedish law of the deceased, which had led to a dramatic decrease in autopsy rates. The aim of this study was to investigate the prevalence of fatal or potential fatal surgical diseases within a Swedish forensic autopsy cohort, before and after this change in legislation.

METHODS

Deaths referred for forensic autopsy at the Institution of Forensic Medicine, Lund University Hospital, Sweden, between 1970-1982 and 2000-2004, were studied regarding the prevalence of aorto-iliac diseases, acute abdomen and abdominal cancer.

RESULTS

The forensic autopsy rates in the population during the two time periods were 14.0% (29 399 patients) and 5.3% (4487 patients), respectively. The total prevalence of surgical diseases has increased significantly from 67.3 (95% confidence interval 64.3-70.2) to 83.4 (74.9-91.8) per 1000 autopsies, respectively. The cause-specific mortality ratios in patients with fatal acute abdomen increased significantly from 16.5 (15.1-18.0) to 39.0 (33.2-44.8) per 1000 autopsies, respectively, and there was almost a three-time increase in patients with fatal gastrointestinal haemorrhage and acute alcohol-related pancreatitis.

CONCLUSION

Forensic autopsy data continues to be invaluable, despite changes in legislation in Sweden, for epidemiological studies on fatal or potential fatal surgical diseases.

An alternative to aorto-uni-iliac EVAR and femoro-femoral crossover in a patient having an aorto-iliac aneurysm with an occluded external iliac artery

INTRODUCTION

An endovascular procedure for excluding an aorto-iliac aneurysm whilst simultaneously preserving one internal iliac artery is described in a patient with complex iliac pathology.

REPORT

The procedure involved the use of Advanta V12 covered stents to bridge the gap between the contralateral limb of the main body of a custom-made Zenith stent graft and the internal iliac artery on the side of an external iliac artery occlusion.

DISCUSSION

Minimal modifications to the standard design of modular stent grafts make it possible to treat high risk patient with complex pathology with minimal morbidity.

Endovascular management of isolated iliac artery aneurysms

OBJECTIVE

We reviewed our experience with endovascular treatment of isolated iliac artery aneurysms (IAAs).

METHODS

Medical records for consecutive patients undergoing endovascular IAA repair from 1995 to 2004 were reviewed. Computed tomography (CT) angiograms were used to assess IAA location, size, and presence of endoleaks after endovascular repair. Rates of primary patency and freedom from secondary interventions were estimated using the Kaplan-Meier life-table method.

RESULTS

From July 1995 to November 2004, 45 patients (42 men), with a mean age of 75 years, underwent endovascular repair of 61 isolated IAAs: 41 common iliac, 19 internal iliac, and one external iliac. Five patients (11%) were symptomatic, although none presented with acute rupture. The mean preoperative IAA diameter was 4.2 +/- 1.7 cm. Fifteen patients (33%) had prior open abdominal aortic aneurysm repair. Local or regional anesthesia was used in 28 cases (62%). Thirty-four patients (75%) were treated with unilateral iliac stent-grafts, eight (18%) with bifurcated aortic stent-grafts, and three (7%) with coil embolization alone. Perioperative major complications included one early graft thrombosis that eventually required conversion to open repair and one groin hematoma that required operative evacuation. On follow-up, late complications included one additional graft thrombosis and one late death after amputation. No late ruptures occurred after endovascular repair, with a mean follow-up of 22 months (range, 0 to 60 months). The mean postoperative length of stay was 1.3 +/- 1.0 days. On postoperative CT scans obtained at 1, 6, 12, 24, and 36 months, aneurysm shrinkage was noted in 18%, 29%, 57%, 67%, and 83% of IAAs, respectively, compared with the baseline diameter. One hypogastric aneurysm enlarged in the presence of a later identified type II endoleak. Five endoleaks were noted (4 type II, 1 indeterminate) at 1 month, with four other endoleaks (1 type II, 1 type III, 2 indeterminate) identified on later CT scans. At 2 years, primary patency was 95%, and freedom from secondary interventions was 88%.

CONCLUSIONS

Endovascular repair of isolated IAAs appears safe and effective, with initial results similar to those after endovascular abdominal aortic aneurysm repair.

Solitary common iliac artery inflammatory aneurysm in a healthy woman: case report and review of the literature

Inflammatory aneurysms represent only 3-10% of all aortoiliac aneurysms and tend to be more common in men. We report a case of a solitary inflammatory aneurysm of the right common iliac artery in a healthy young woman. The patient presented with persistent abdominal and right flank pain. She had no risk factors for vascular disease, except mild hypertension and a strong family history of aneurysm disease. Her work-up demonstrated a 3.0 cm right common iliac artery aneurysm with intramural thrombus, focal calcification, and perianeurysmal inflammation without evidence of systemic atherosclerosis. There was right hydroureteronephrosis secondary to ureteral compression by the inflammatory aneurysm. She underwent open right common iliac artery aneurysmorraphy with polytetrafluoroethylene interposition graft and concomitant ureterolysis without complication. She remains asymptomatic more than 1 year postoperatively with no evidence of additional aneurysm disease, resolution of her hydroureteronephrosis, and normal kidney function. We report a rare case of a solitary inflammatory aneurysm of the right common iliac artery in a healthy young woman, with a review of the current literature on inflammatory aneurysms.

Preoperative Risk Stratification in Patients Undergoing Elective Infrarenal Aortic Aneurysm Surgery: Evaluation of Five Risk Scoring Methods

OBJECTIVE

To evaluate five risk scoring methods in predicting the immediate postoperative outcome after elective open repair of abdominal aortic aneurysm (AAA).

DESIGN

Retrospective evaluation of the Eagle score, Glasgow aneurysm score, Leiden score, modified Leiden score and Vanzetto score in a consecutive series of patients.

PATIENTS

Two hundred and eighty-six consecutive patients undergoing elective infrarenal aortic aneurysm repair.

RESULTS

Nine patients (3.1%) died in hospital and another 35 (12%) experienced severe postoperative complications. For the Glasgow aneurysm score, Leiden score, modified Leiden score and Vanzetto score receiver operating characteristics (ROC) curve analysis for prediction of in-hospital mortality showed area under the curve (AUC) of 0.749 (p=0.01), 0.777 (p=0.008), 0.788 (p=0.006) and 0.794 (p=0.005), respectively. The Eagle risk score was less accurate for predicting in-hospital mortality. The risk-scoring systems did not perform well in predicting post-operative complications, but multivariate analysis showed that the modified Leiden score was an independent predictor of postoperative complications.

CONCLUSION

All scoring systems predict, with reasonable accuracy, the risk of in-hospital death in patients undergoing elective open repair of AAA, whereas the accuracy in predicting severe postoperative complications is less.

Aortic aneurysm repair with endovascular grafts: developing a graft surveillance program

The objective of this study was to describe the development of a comprehensive surveillance program for monitoring the long-term follow-up of endoluminal stent graft (ELG) patients. Despite high procedural success rates, ELG patients remain at ongoing risk for aneurysm sac expansion, rupture, and other adverse events that make long-term surveillance imperative. As they perform more ELG, practitioners face increased logistical difficulty performing appropriate patient follow-up. A computer-based data ELG registry was created using Epi Info, a program developed by the Centers for Disease Control and Prevention that enables users to design a data entry form, enter data, and perform statistical analyses. The database has been used to track 259 patients (214 men and 45 women) who underwent ELG between November 1999 and October 2003. One-year follow-up was available for 182 patients, 2-year follow-up for 104 patients, and 3-year surveillance data for 40 patients, which represent follow-up rates of 89.6%, 78.8%, and 61.5%, respectively. There were 25 late deaths. The Kaplan-Meier estimate for 1-year survival was 92.5%. Twenty-one patients underwent 24 secondary angiographic procedures at a mean 8.6 +/- 10.3 months (range, 1-37.6) after stent-graft repair. No mortality was observed in association with a secondary intervention. There were no late conversions to open aneurysm repair. The Kaplan-Meier estimate for freedom from secondary intervention for all patients at 1 year was 91.0%. A computer-based registry facilitates appropriate and timely patient follow-up and may improve the long-term outcome from ELG.

Descending Thoracic and Thoracoabdominal Aortic Aneurysm Repair: 15-Year Results Using a Uniform Approach

This review presents the results of surgical repair of descending thoracic (DT) and thoracoabdominal aortic (TAA) aneurysms, using spinal drainage (SD) distal aortic perfusion (DAP), and other adjuncts intended to reduce complications. Records of patients undergoing repair of DT and TAA between 1986 and 2002 were reviewed. Elective operations were performed using single lung ventilation, invasive monitoring, SD, modest anticoagulation, permissive hypothermia (> or = 33 degrees F), liberal use of transaortic endarterectomy, and complete repair. Intercostal arteries were reimplanted when possible and DAP was used in DT and TAA types I, II, and III repair. Exceptions to this approach were noted. Some of these adjuncts were used in emergency cases. Actuarial survival was calculated. Fifty consecutive patients with DT (3) or TAA (47), type I (4), type II (16), type III (18), or type IV (9), aneurysms received elective (36) or emergency (14) repair between 1986 and 2002. Mortality was 2/36 (5.5%) in the elective group. In the emergency group, there were 2 intraoperative deaths and mortality was 4/14 (28.5%, p < 0.07). Overall survivor morbidity was 6/34 (17.6%) in elective and 7/10 (70%, p < 0.02) in emergency cases. Paraplegia occurred in one patient in the elective group (2.7%) with dissecting type II TAA aneurysm in whom the intercostal patch was sacrificed. Two of 12 initial survivors developed paraplegia in the emergency group (16.7%); one had SD but neither had DAP or intercostal reimplantation. Serious complications were associated with avoidable deviations from the approach. Five and 10-year survival for the entire series was 64.8% and 46.4%, respectively. These results parallel those in contemporary reports from centers where repair of descending and thoracoabdominal aortic aneurysm is frequently performed. Good long-term results can be achieved using spinal drainage and distal aortic perfusion, combined with other adjuncts as a means of reducing complications. When possible, the same approach should be used in emergency cases.

A comparative study of iliac and abdominal aortic aneurysms

BACKGROUND

The aim of the paper is to compare the epidemiology, risk factors and manifestations of iliac and abdominal aortic aneurysms.

METHODS

Two studies were used: 1. 5,470 65-73-year-old men invited for screening for abdominal aortic aneurysms. 2. Review of all 350 patients operated on for central aneurysms in the county of Viborg, Denmark from 1989-1997.

RESULTS

4,176 attended for screening. One hundred and seventy (4.0%) had an abdominal aortic aneurysm. Twenty-one (0.56%) needed operation. The proportion of patients with common iliac aneurysms requiring surgery was 0.17%. The operative incidence of iliac aneurysm was 18.4 per million per year, and 92.4 per million per year were operated on for abdominal aortic aneurysm. The mean serum cholesterol level for isolated iliac aneurysm and combined aneurysms was significantly lower compared to isolated abdominal aortic aneurysm (p<0.05). Urological symptoms were present in 42% of cases with isolated iliac aneurysm, and 25% of combined aneurysms compared to 8% of isolated abdominal aortic aneurysms. Fifty-eight percent of the isolated iliac aneurysms were ruptured, as against 27% of the abdominal aortic aneurysms. The peri- and postoperative mortality was 57% in ruptured isolated iliac aneurysms, 47% in ruptured combined aneurysms, and 31% in ruptured isolated aortic aneurysms.

CONCLUSIONS

Iliac aneurysms seem to be more underdiagnosed than abdominal aortic aneurysms, and are often diagnosed because of clinical manifestations, especially urological, or rupture. Iliac aneurysms seem more lethal than those of the abdominal aorta in cases of rupture.

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.

Infected aneurysms--clinical study of 5 cases

The infected aneurysm has been assumed to be a disease with a poor prognosis due to the occurrence of aneurysmal ruptures and sepsis, in contrast to the outcome of atherosclerotic aneurysms. In the present study, we conducted surgical treatment on five patients with infected aneurysms (infected abdominal aortic aneurysm in three cases and iliac artery aneurysm in two cases). In particular, two of the three patients suffering from infected abdominal aortic aneurysms underwent extra-anatomic bypass and the remaining one case underwent vascular graft replacement in situ. In the two patients who underwent an extra-anatomic bypass, an aneurysm was found at the site of aortic stump closure. In the patient who underwent in situ replacement, wrapping was carried out using the omentum after vascular graft replacement, and the postoperative course was uneventful. Accordingly, we consider that the optimum primary therapeutic intervention for infected aneurysms is in situ revascularization followed by wrapping with the omentum after removal of the aneurysm and debridement of the surrounding infected tissue to the maximum extent possible.

The incidence of iliac, femoral, and popliteal artery aneurysms in hospitalized patients

PURPOSE

Previous studies have attempted to determine the incidence and mortality rate of abdominal aortic aneurysms in a variety of populations; however, the incidence of iliac, femoral, and popliteal artery aneurysms have not been established. The objective of this study was to determine the incidence of lower extremity aneurysms in hospitalized patients in the state of Utah, which has a population at low risk for cardiovascular disease, atherosclerosis, and smoking, and to compare the results with the incidence in the United States.

METHODS

Incidences of iliac, femoral, and popliteal artery aneurysm in Utah were determined over a 6-year period, with data obtained via diagnostic codes from the Utah Hospital Association. The incidence of iliac, femoral, and popliteal artery aneurysms in the United States hospital population was calculated by use of National Hospital Discharge Summary 1990 data, a complex sample of nonfederal short-stay hospitals in the United States, which provides the most comprehensive database of health statistics in the United States.

RESULTS

The incidence of iliac femoral/popliteal artery aneurysms in hospitalized Utah men is 3.76 and 4.85 per 100,000 population, respectively. In American men, iliac and femoral/popliteal artery aneurysm incidences are 6.58 and 7.39 per 100,000 population, respectively. Incidences among hospitalized women in Utah are 0.24 and 1.07 per 100,000; incidences in women in the United States are 0.26 and 1.00 per 100,000, respectively. The incidence of nonaortic peripheral aneurysms among hospitalized patients in Utah is lower than in the United States. The rate ratios (Utah/United States) for incidences of iliac, femoral, and popliteal artery aneurysms in men are 0.57 and 0.66, respectively (p < 0.05). No statistical difference is seen between incidences in women in Utah and the United States (p > 0.05)-ratios of 0.93 and 1.06, respectively.

CONCLUSION

This study validates the traditional belief that iliac, femoral, and popliteal artery aneurysms are much less frequent, at least in hospitalized patients, than previously published incidences of abdominal aortic aneurysms.

Iliac artery MR angiography: comparison of three-dimensional gadolinium-enhanced and two-dimensional time-of-flight techniques

PURPOSE

To determine if a three-dimensional (3D) gadolinium-enhanced technique is useful for improving the accuracy of magnetic resonance (MR) angiography.

MATERIALS AND METHODS

Prospectively, two-dimensional (2D) time-of-flight (TOF) and 3D gadolinium-enhanced MR angiography was performed in 23 patients. Conventional arteriography, the reference standard, was performed in all but five patients. Images from each examination were interpreted blindly by two observers.

RESULTS

For common and external iliac arteries, interpretations of dynamic 3D gadolinium-enhanced MR angiograms matched those of conventional arteriograms in 12 of 18 patients (67%) for both observers. Interpretations of 2D TOF images matched those of conventional arteriograms in six (33%) and seven (39%) patients for the two observers respectively.

CONCLUSION

Preliminary results suggest that iliac artery MR angiography can be improved by complementing standard 2D TOF acquisitions with 3D gadolinium-enhanced acquisitions.

Strecker stent implantation in iliac arteries: patency and predictive factors for long-term success

PURPOSE

To evaluate Strecker stent implantation in iliac arteries.

MATERIALS AND METHODS

Sixty-four iliac arteries with Strecker stents were prospectively studied. Stents were placed for dissection (n = 31), total occlusion (n = 28), unsatisfactory results (n = 3) or restenosis (n = 1) after percutaneous transluminal angioplasty, and a calcified atherosclerotic lesion that bulged into the lumen (n = 1).

RESULTS

Stent placement was successful in 63 arteries (98%). The overall complication rate was 12% (n = 8). During follow-up, three patients died. The stent was compromised in 18 cases because of hyperplasia (n = 10) or occlusion (n = 8). The primary patency rate was 84% at 1 year and 69% at 2 years; the secondary patency rate was 90% at 1 year and 81% at 2 years. Initial dissection (P = .046), a length of 60 mm or less for the stent region (P = .007), and total covering of the abnormal segment with the stent (P = .03) were significant predictive factors for good, long-term results.

CONCLUSION

Use of the Strecker endoprosthesis appears useful but not ideal. Determination of predictive factors for long-term success may help identify indications for its use.

[Prevalence of intraabdominal aneurysm in elderly patients]

BACKGROUND

A study in old patients on the incidence of aneurysms in abdominal arteries (AAA) and on the maximum diameter of the aorta below the renal arteries in those patients without arterial dilatation.

MATERIAL AND METHODS

The study comprised 411 individuals, 218 women and 153 men with an average age of 74.4 years. Physical examination of the abdomen (EF) and abdominal ultrasonography (US) were done, and the latter was considered the "golden standard" of reference. In relation to the aorta, it was considered as an aneurysm the maximum artery diameter larger than 30 mm and for the iliac arteries, the maximum diameter larger than 15 mm.

RESULTS

The US showed the presence of aneurysm in the aortic-iliac territory in nine patients, one woman and eight men, corresponding to a prevalence of 2.1%, 4.1% in men and 0.4% in women. Two such aneurysms were in the iliac arteries (one aneurysm in a common iliac artery) and the other seven in the aorta below the renal arteries. The bearers of iliac aneurysm are men. The prevalence of the AAA was of 1.7% (7/411), 3.1% in men and 0.4% in women. The EF showed suspicion of the presence of aneurysm in 3 of these patients. The other 6 patients had no aneurysm. Considering all the aneurysms of the aortic-iliac territory, the EF had a sensitivity of 33.3%, a specificity of 99% and a positive prediction value of 33.3%. Considering only AAA, the sensitivity of the EF was 42.8%, the specificity 98.5%, and the positive prediction value, 33%. In the 402 patients without arterial aneurysm the maximum diameter of the aorta varied from 11 to 29 mm, with an average value of 16-21 mm.

CONCLUSIONS

US is a non-invasive diagnostic procedure that should be used for the old age population.

Early results of 132 aortic or aorto-iliac arterial reconstructions with the new Stretch ePTFE vascular prosthesis

OBJECTIVE

The purpose of the present study is to document the short term clinical results after implantation of the new Stretch ePTFE (Gore-Tex) arterial prostheses in patients with aortic or aorto-iliac occlusive atherosclerotic disease or aneurysm.

STUDY DESIGN

A descriptive, prospective and non-randomized clinical series with clinical follow-up at three and 12 months.

SETTING

The study was performed at an Academic Vascular Surgery Unit.

PATIENTS

Within 20 months we consecutively implanted 379 prostheses (tubes or bifurcations): 132 Stretch ePTFE (Gore-Tex) and 247 Dacron (Unigraft, Braun-Melsungen) grafts.

RESULTS

There was no intraoperative deaths. Nine of 217 patients (= 4%) with occlusive atherosclerotic disease died < 30 days postoperatively; the mortality rate for asymptomatic aortic aneurysm was 8% (7/91), for symptomatic aneurysm 13% (4/30), and for ruptured aneurysm 22% (8/36). The primary patency of the aortic or aorto-iliac grafts was 99%, secondary patency at three months and one year 100 per cent. One patient with Stretch prosthesis developed a superficial groin infection, and one developed infection of an aortic tube graft. In the Dacron series six patients developed superficial groin infection, and two deep infections occurred. No graft-enteric fistulas or erosions were seen, and by clinical examination no anastomotic aneurysm developed. Five patients had in situ replacement of a pan-infected Dacron bifurcation graft with a Gore-Tex Stretch graft. With an observation time from 50 to 400 days these five patients are well without clinical signs of infection.

CONCLUSIONS

These short term results with implantation of aortic or aorto-iliac Stretch ePTFE prostheses are encouraging and will provide the basis for a continuing performance trial with long term follow-up and reporting.

Ulcerated plaques and focal aneurysms of iliac arteries: treatment with noncovered, self-expanding stents

OBJECTIVE

We studied the value of noncovered, self-expanding stents for treatment of ulcerated plaques and focal aneurysms of iliac arteries.

MATERIALS AND METHODS

Seventeen patients with ulcerated plaques (n = 13) and aneurysms (n = 5) were treated with noncovered, self-expanding Wallstent endoprostheses. A total of 18 lesions were stented. The lesions were in the common iliac artery (n = 10), the external iliac artery (n = 3), or affected parts of both arteries (n = 5). Their mean length was 3.5 +/- 1.0 cm. All lesions were accompanied by stenosis of the affected arterial segment.

RESULTS

Occlusion of ulcerations or aneurysms occurred immediately in three cases and thereafter in the remaining 15 cases, as shown by angiographic follow-up. Embolization did not occur. Follow-up revealed a 4-year cumulative patency of 82%, with reobstruction of the stent in three cases.

CONCLUSION

Noncovered stents are a rational approach to treating circumscribed aneurysms and ulcerated plaques of the iliac arteries. The stent regularly smoothens the vessel wall by sealing the ulcerated area or aneurysm immediately or soon after stent placement.