[Bilateral iliac artery aneurysms in a Behçet-like disease]

A case of bilateral iliac artery aneurysms in a 24 year old patient with a Behçet-like disease is presented. Behçet's disease is characterized by multiple organ involvement. Primary manifestations are genital and oral mucosal ulcerations and eye and skin affections. Among secondary manifestations are non-specific arteritis causing thrombosis as well as aneurysmal disease of the medium-sized and large arteries. Behçet's disease should be considered in young patients with arterial aneurysms.

Iliac aneurysm in a child complicating umbilical artery catheterization

We report a case of an iliac artery aneurysm in a 9-year-old girl due to Staphylococcus aureus infection of an umbilical arterial catheter inserted at birth. After resection-anastomosis of the iliac artery the postoperative course was uneventful and hemodynamic data remain normal at 2 years. A review of the literature indicates that the prognosis of infective aortoiliac aneurysm is poor in children, except when the aneurysm is located solely in the iliac artery. Arterial continuity should be restored as late as possible after infection using a technique consistent with normal growth of the artery in the child.

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.

Late complications after aortic surgery

The incidence of false aneurysms, anastomotic stenoses, and ureteric obstruction is reported to be low in patients who have undergone aortic surgery. The use of intravenous peripheral digital subtraction angiography (IVDSA) with completion excretory urography (CEU) may provide a more sensitive means of long-term detection of these complications. The aim of this study was to (1) establish the incidence of anastomotic aneurysms, anastomotic stenoses, and ureteric obstruction after aortic surgery; (2) identify local and systemic factors that predispose to these complications; and (3) evaluate IVDSA as a single radiologic investigation to diagnose these complications. Forty-four patients who had undergone aortic surgery 1 to 12.3 years previously agreed to undergo IVDSA and CEU. False aneurysms were found at 10 distal anastomoses (none at the aorta), for an anastomotic incidence of 11.2% and a patient incidence of 15.9%. Endarterectomy and the femoral artery as a site of distal anastomosis were important factors in the development of anastomotic aneurysms, as were detected radiologically at eight aortic anastomosis (18%). There were no distal anastomotic stenoses. Hypercholesterolemia was more common in this group (62.5%) than in the overall group (21.2%). Three asymptomatic ureteric obstructions were diagnosed in two patients, both of whom had emergency surgery for ruptured aortic aneurysms. The higher incidence of anastomotic aneurysms, anastomotic stenoses, and asymptomatic ureteric obstruction sound merits careful follow-up. IVDSA with CEU may be a simple and effective method of detection.

Rare presentation of anastomotic iliac artery false aneurysm: rupture with formation of ilio-iliac arteriovenous fistula

A rare complication of aortoiliac bypass procedure resulting in the formation of an acute ilio-iliac arteriovenous fistula was presented. The latter was a first manifestation of anastomotic iliac pseudoaneurysm. This is only the second such case reported in the English literature. Iliac anastomotic pseudoaneurysm although rarely detected, is a potentially lethal complication that has to be repaired close to the time of its detection.

Iliac artery aneurysms. Radiographic evaluation

We present seventeen cases of iliac artery aneurysm employing a variety of different imaging modalities (ultrasound, computed tomography, arteriography, magnetic resonance imaging). The utility of each of these techniques in the patient with iliac artery aneurysm is described.

[Isolated hypogastric artery aneurysm ruptured into urinary bladder: a case report]

An 81-year-old man was admitted to our hospital with a complaint of dysuria. He had had a right hypogastric aneurysm repaired three years earlier. Physical examination showed a distended soft abdomen and tender mass about the size of a child's head but no murmur was heard over the mass. An excretory urogram (DIP) showed left hydronephrosis and no excretion from the right kidney. Computerized tomography (CT) showed urinary bladder compressed by the mass on the upper right back side. Cystography showed that the large mass occupied the pelvic region with calcification and communicated with the bladder. After a few days, an operation for the aneurysm was undertaken by the surgical department. Although bilateral ureterolysis was possible, a resection of the aneurysm could not be done. The aneurysm was injected with fibrin adhesive and a bilateral nephrostomy was performed. The renal function has been stable and the size of the aneurysm has remained unchanged for 9 months after the surgery.

[Pulsatile vaginal expansion: Case report of an internal iliac aneurysm detected after an injury]

After a pelvic trauma, in a 78 years old women, systematic radiograms showed a polycyclic mass in the left side of the pelvis. This finding was confirmed by B-mode ultrasound echography. The vaginal touch found a pulsatile and expanding mass. At surgery, the diagnosis of a fissuring aneurysm of the internal iliac artery was confirmed, and a curative treatment was undertaken. Reviewing the literature, the authors emphasize the diagnostic usefulness of rectal and vaginal touch, and the importance of an early diagnosis using noninvasive imaging techniques. Surgery is the only treatment for isolated internal iliac aneurysms.

Hypogastric artery aneurysm masquerading as an ovarian neoplasm

Hypogastric artery aneurysm in women is rare. The case presented demonstrates how this lesion can easily mimic an ovarian neoplasm. The missed diagnosis can be catastrophic if the surgeon is unfamiliar with the retroperitoneal anatomy and is confronted with arterial hemorrhage. Hypogastric artery aneurysm should be included in the differential diagnosis of a pelvic mass in elderly women with atherosclerotic disease. The report reviews the literature on the presentation, diagnosis, and recommended treatments.