Iliac artery aneurysms. Radiographic evaluation

Urinary retention revealing a large common iliac artery aneurysm

Isolated aneurysms of the common iliac artery are rare, affecting less than 0.01% of the general adult population. Most of these aneurysms are asymptomatic and are discovered as an incidental finding. We describe an elderly patient presented with a urinary retention, which the investigations had led to the diagnosis of a large left common iliac artery aneurysm.

Ultrasound evaluation of abdominal aortic and iliac aneurysms and mesenteric ischemia

The role of US in imaging of the abdominal vasculature has broadened over recent years. Long considered the modality of choice in the detection of AAA, its use has expanded to diagnosing and monitoring IAAs and PAAs, screening for mesenteric ischemia, and posttreatment monitoring of endovascular stents.

Equilibrium-phase MR angiography of the aortoiliac and renal arteries using a blood pool contrast agent

OBJECTIVE

The purpose of this study was to determine the diagnostic usefulness of a new blood pool contrast agent, NC100150, for assessing the aortoiliac and renal arteries.

SUBJECTS AND METHODS

Twenty patients with hemodynamically significant stenosis (> or =50% of luminal diameter) of the iliac or renal arteries or an aortic aneurysm documented by digital subtraction angiography underwent MR angiography at 1.5 T after administration of NC100150. Three-dimensional MR angiographic data sets were collected ill the equilibrium phase. In a prospective analysis, each vascular segment (16 segments per arterial tree) was evaluated.

RESULTS

All patients tolerated the NC100150 administration well. Mean contrast-to-noise ratios of the vascular data collected in the equilibrium phase of NC100150 was 3.3+/-15.9. Compared with digital subtraction angiography, the sensitivity and specificity of MR angiography for the renal arteries were 82% and 98%, respectively; for the common iliac arteries, 86% and 97%, respectively; for the external iliac arteries, 80% and 100%, respectively; and for the internal iliac arteries, 71% and 977, respectively. All 83 aneurysmal changes revealed by digital subtraction angiograpy of the aortoiliac arteries were well displayed on the MR angiographic data sets.

CONCLUSION

Equilibrium-phase NC 00150-enhanced three-dimensional MR angiography shows high specificity when evaluating the abdominal and pelvic vascular systems, but the attendant venous overlap can limit the assessment of stenosis in renal and pelvic arterial segments.

Covered stent implantation by the puncture method for the treatment of a small aneurysm of the common iliac artery

A method to repair endovascular aneurysms with covered stents has recently been developed. In the present paper, the implantation of a covered stent through a 12Fr sheath by the puncture method for the treatment of an isolated aneurysm of the right common iliac artery is reported. The aneurysm was less than 3 cm in diameter, and computed tomography showed no signs of aneurysm rupture, but the patient nonetheless complained of right lower abdominal pain and constipation. It was decided to implant a covered stent in lieu of surgical repair because it was difficult to prove a causal relationship between the aneurysm and the patient's complaints. Fortunately, after implantation, the symptoms were resolved. In conclusion, it is possible to choose this less invasive type of therapy for the treatment of an isolated iliac artery aneurysm if the patient complains only of general malaise and there are no certain signs of an impending rupture, although surgery should be indicated regardless of aneurysm size.

Placement of a PTFE-covered Wallstent through a 12 Fr sheath for the exclusion of a common iliac artery aneurysm

We describe a technique for transfemoral endovascular exclusion of an iliac artery aneurysm with a reconstrained polytetrafluoroethylene (PTFE)-covered Wallstent inserted through a 12 Fr sheath after right femoral artery cutdown. The procedure was successfully performed, with evidence of complete aneurysm exclusion at 4-month follow-up. This technique reduces the caliber of the introducer needed to deploy the covered Wallstent. It should be noted that because of a leak, an additional covered Palmaz stent was also deployed.

Enteric fistulization of a common iliac artery aneurysm: an unusual cause of gastrointestinal hemorrhage and shock

A 78-year-old man with a history of recent unexplained lower gastrointestinal bleeding presented to the emergency department with the acute onset of abdominal pain, tenesmus, and shock. Computed tomography of the abdomen showed a fistula between a common iliac artery aneurysm and the small intestine. Laparotomy demonstrated a saccular aneurysm of the common and proximal internal iliac arteries with fistulous communication to the distal ileum. Aneurysmectomy, arteriorrhaphy, and segmental ileal resection with primary anastomosis were successfully performed. This case illustrates a rare complication of an uncommon aneurysm, emphasizing the need for emergency physicians to consider complicated vascular disease in the evaluation of a patient with abdominal pain and shock.

Isolated atherosclerotic aneurysms of the iliac arteries

Atherosclerotic aneurysms limited to the iliac arteries are rare and entail a high risk of rupture. To evaluate the efficacy of prophylactic surgery, we retrospectively studied 15 patients (13 men and two women; mean age 69 years) treated for isolated iliac aneurysms in the Department of Cardiovascular Surgery at the University Hospital of Liège over a period of 18 years. They had a total of 25 aneurysms (20 common iliac and five internal iliac). Six patients were treated electively and nine on an emergency basis for rupture. Five of the emergency patients (33%) died in the early postoperative period (< 30 days); in each case the aneurysm had ruptured and an emergency operation was performed (55.5% mortality in the ruptured iliac aneurysm group). On the other hand, all patients treated electively survived. Our study is comparable to other recent series in the literature, which also reported a high incidence of rupture and death in emergency operations. Prophylactic elective surgery is recommended for iliac aneurysms.