1
|
A Rare Presentation of Abdominal Aortic Aneurysm-Renal Pelvis Rupture Due to Compression. Ann Vasc Surg 2017; 46:368.e1-368.e4. [PMID: 28887257 DOI: 10.1016/j.avsg.2017.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/19/2017] [Accepted: 07/21/2017] [Indexed: 11/20/2022]
Abstract
Abdominal aortic aneurysms (AAAs) are usually asymptomatic. The compressive effects of internal iliac aneurysms are well described in the literature; however, we report what we believe to be the first case of rupture of the renal pelvis caused by compression by an infrarenal AAA. We describe the subsequent management and briefly review the literature.
Collapse
|
2
|
Dierks A, Sauer A, Wolfschmidt F, Hassold N, Kellersmann R, Bley TA, Kickuth R. Proximal occlusion of unaffected internal iliac artery versus distal occlusion of aneurysmatic internal iliac artery prior to EVAR: a comparative evaluation of efficacy and clinical outcome. Br J Radiol 2017; 90:20160527. [PMID: 28256907 DOI: 10.1259/bjr.20160527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Occlusion of the internal iliac artery (IIA) may be necessary prior to endovascular aneurysm repair (EVAR) to prevent endoleak Type II. We compared efficacy and clinical outcome after proximal occlusion of an unaffected IIA (ProxEmbx) using an Amplatzer vascular plug (AVP) I vs distal occlusion of aneurysmatic IIA with coils and plugs (DistEmbx). METHODS Between 2009 and 2012, 22 patients underwent EVAR. In 9 patients with unaffected IIA, occlusion was performed by a single AVP. In 13 patients with aneurysmatic IIA, more distal embolization (DistEmbX) was conducted by using several coils and additional AVPs. Retrospectively, technical success, clinical outcome and complications were evaluated. RESULTS Embolization of the IIA was successful in all patients. Three patients with more DistEmbX of aneurysmatic IIAs suffered from new onset of sexual dysfunction after occlusion without statistically significant difference (p > 0.05). Transient buttock claudication was observed in three patients in each group. Bowel ischaemia did not occur. The procedure time (p = 0.013) and fluoroscopy time (p = 0.038) was significantly lower in the ProxEmbx group than in the DistEmbx group. CONCLUSION Proximal occlusion of an unaffected IIA and more distal occlusion of an aneurysmatic IIA prior to EVAR had the same technical and clinical outcome. However, proximal plug embolization of an unaffected IIA prior to EVAR was associated with shorter procedure and fluoroscopy time in comparison with more DistEmbX of aneurysmatic IIAs. Advances in knowledge: Proximal embolization of unaffected IIA and DistEmbX of aneurysmatic IIA before EVAR are both effective in preventing Type II endoleaks and have the same technical and clinical outcome.
Collapse
Affiliation(s)
- Alexander Dierks
- 1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany
| | - Alexander Sauer
- 1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany
| | - Franziska Wolfschmidt
- 1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany
| | - Nicole Hassold
- 1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany
| | - Richard Kellersmann
- 2 Department of General, Visceral, Vascular and Paediatric Surgery, University of Wuerzburg, Würzburg, Germany
| | - Thorsten A Bley
- 1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany
| | - Ralph Kickuth
- 1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany
| |
Collapse
|
3
|
Kakkos SK, Bicknell CD, Tsolakis IA, Bergqvist D. Editor's Choice - Management of Secondary Aorto-enteric and Other Abdominal Arterio-enteric Fistulas: A Review and Pooled Data Analysis. Eur J Vasc Endovasc Surg 2016; 52:770-786. [PMID: 27838156 DOI: 10.1016/j.ejvs.2016.09.014] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 09/25/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To compare management strategies for secondary abdominal arterio-enteric fistulas (AEFs). METHODS This study is a review and pooled data analysis. Medline and Scopus databases were searched for studies published between 1999 and 2015. Particular emphasis was given to short- and long-term outcomes in relation to AEF repair type. RESULTS Two hundred and sixteen publications were retrieved, reporting on 823 patients. In-hospital mortality was 30.7%. Open surgery had higher in-hospital mortality (246/725, 33.9%), than endovascular methods (7/98, 7.1%, p < .001, OR 6.7, 95% CI 3-14.7, including staged endovascular to open surgery, 0/13, 0%). In-hospital mortality after graft removal/extra-anatomical bypass grafting was 31.2% (66/226), graft removal/in situ repair 34% (137/403), primary closure of the arterial defect 62.5% (10/16), and for miscellaneous open procedures 41.3% (33/80), p = .019. Among the subgroups of in situ repair, homografts were associated with a higher mortality than impregnated prosthetic grafts (p = .047). There was no difference in recurrent AEF-free rates between open and endovascular procedures. Extra-anatomical bypass/graft removal and in situ repair had a lower AEF recurrence rate than primary closure and homografts. Late sepsis occurred more often after endovascular surgery (2-year rates 42% vs. 19% for open, p = .001). The early survival benefit of endovascular surgery was blunted during follow-up, although it remained significant (p < .001). Within the in situ repair group, impregnated prosthetic grafts were associated with the worst overall and AEF related mortality free rates and vein grafts with the best. No recurrence, sepsis, or mortality was reported following staged endograft placement to open repair after a mean follow-up of 16.8 months (p = .18, p = .22, and p = .006, respectively, compared with patients in other groups). CONCLUSIONS Endovascular surgery, where appropriate, is associated with better early survival than open surgery for secondary AEFs. Most of this benefit is lost during long-term follow-up, implying that a staged approach with early conversion to in situ vein grafting may achieve the best results in selected patients.
Collapse
Affiliation(s)
- S K Kakkos
- Department of Vascular Surgery, University Hospital of Patras, Greece; Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK.
| | - C D Bicknell
- Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK
| | - I A Tsolakis
- Department of Vascular Surgery, University Hospital of Patras, Greece
| | - D Bergqvist
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | | |
Collapse
|
4
|
Policha A, Baldwin M, Mussa F, Rockman C. Iliac Artery-Uretero-Colonic Fistula Presenting as Severe Gastrointestinal Hemorrhage and Hematuria: A Case Report and Review of the Literature. Ann Vasc Surg 2015; 29:1656.e1-6. [DOI: 10.1016/j.avsg.2015.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 07/14/2015] [Accepted: 07/30/2015] [Indexed: 12/01/2022]
|
5
|
Yanase Y, Fukada J, Tamiya Y. Internal iliac artery aneurysmo-colonic fistula after endovascular stent-graft repair: a case report. Ann Vasc Dis 2015; 8:46-8. [PMID: 25848433 DOI: 10.3400/avd.cr.14-00109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/12/2014] [Indexed: 11/13/2022] Open
Abstract
We describe rare ilio-enteric fistula that developed after endovascular repair of a left internal iliac artery aneurysm (IIAA). An 83-year-old man with a history of previous surgeries via laparotomies suddenly developed a high fever 3 years after undergoing endovascular abdominal aortic repair (EVAR) with a stent-graft to treat a left isolated IIAA. Computed tomography imaging revealed a fistula between the IIAA and the sigmoid colon. A colostomy was created because severe intraperitoneal adhesions prevented resection of the IIAA. The postoperative course was uneventful and the patient remained free of infection without antibiotics. Residual aneurysms can cause complications after EVAR.
Collapse
Affiliation(s)
- Yohsuke Yanase
- Department of Cardiovascular Surgery, Otaru Municipal Medical Center for Brain, Cardiovascular and Mental Disorders, Otaru, Hokkaido, Japan
| | - Johji Fukada
- Department of Cardiovascular Surgery, Otaru Municipal Medical Center for Brain, Cardiovascular and Mental Disorders, Otaru, Hokkaido, Japan
| | - Yukihiko Tamiya
- Department of Cardiovascular Surgery, Otaru Municipal Medical Center for Brain, Cardiovascular and Mental Disorders, Otaru, Hokkaido, Japan
| |
Collapse
|
6
|
Arthur TI, Gillespie CJ, Butcher W, Lu CT. Pseudoaneurysm of the internal iliac artery resulting in massive per-rectal bleeding. J Surg Case Rep 2013; 2013:rjt069. [PMID: 24964318 PMCID: PMC3855167 DOI: 10.1093/jscr/rjt069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Rectal bleeding is a common reason for presentation to hospital, with large bleeds most commonly caused by diverticular disease and angiodysplasia. Here we present an unusual aetiology of massive per-rectal bleeding attributable to pseudoaneurysm of the internal iliac artery leading to an arterial fistula to the distal large bowel. It is hoped the case will serve as a reminder that rectal bleeding can have a less common aetiology.
Collapse
Affiliation(s)
- T I Arthur
- Department of General Surgery, Gold Coast Hospital, Gold Coast, Australia
| | - C J Gillespie
- Department of General Surgery, Gold Coast Hospital, Gold Coast, Australia
| | - W Butcher
- Department of Vascular Surgery, Gold Coast Hospital, Gold Coast, Australia
| | - C T Lu
- Department of General Surgery, Gold Coast Hospital, Gold Coast, Australia
| |
Collapse
|
7
|
Endovascular treatment of isolated iliac artery aneurysms with anaconda stent graft limb. Case Rep Vasc Med 2013; 2013:527492. [PMID: 23862094 PMCID: PMC3703722 DOI: 10.1155/2013/527492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 06/04/2013] [Indexed: 11/23/2022] Open
Abstract
Isolated aneurysms of the iliac arteries are relatively rare conditions that traditionally have been treated by surgical reconstruction. We report our experience with endovascular treatment of iliac artery aneurysms (IAAs) with Anaconda stent graft limb. Two male patients were found to have 4.5 and 3.6 cm isolated common IAAs, respectively. The endograft was successfully advanced and deployed precisely to the intended position in both cases. In one case the internal iliac artery was embolized. No type I or II endoleak was observed immediately after the procedure. In one patient postimplantation fever (>38°C) and gluteal claudication occurred. After 2 years followup both iliac endovascular stent grafts are patent and without endoleak. Endovascular treatment with Anaconda limb stent graft seems to be a safe and feasible alternative to open surgery.
Collapse
|
8
|
Abstract
The ruptured hypogastric artery aneurysm (RHAA) is a rare clinical entity with an evolving and dynamic therapeutic armamentarium. The anatomical location and varied clinical presentation can pose a challenge for successful repair. Recently, endovascular and hybrid operative repairs have significantly improved the historically high-operative mortality rate. We present an illustrative case and contemporary review of the literature with respect to RHAA.
Collapse
Affiliation(s)
- Marvin E. Morris
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapeutics, University of Louisville, Louisville, KY, USA
| | - Katherine M. Huber
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapeutics, University of Louisville, Louisville, KY, USA
| | - John G. Maijub
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapeutics, University of Louisville, Louisville, KY, USA
| |
Collapse
|
9
|
Antoniou GA, Nassef AH, Antoniou SA, Loh CYY, Turner DR, Beard JD. Endovascular treatment of isolated internal iliac artery aneurysms. Vascular 2011; 19:291-300. [PMID: 22048976 DOI: 10.1258/vasc.2011.ra0050] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of the paper is to evaluate the outcome of endovascular treatments for isolated internal iliac artery aneurysms. A systematic review of the literature using public domain databases was undertaken. All studies reporting on endovascular treatment of isolated hypogastric artery aneurysms were considered. Experience from our institution was involved in the data analysis. The primary outcome measures were technical success, perioperative, and overall mortality and morbidity. Data were extracted from 30 articles fulfilling the selection criteria, and the study cohort consisted of 55 patients having undergone treatment of 59 internal iliac artery aneurysms. Ten patients (18%) were treated on an urgent or emergency basis for a ruptured aneurysm. Technical success was achieved in 71% of the cases. The most common reason for technical failure was incomplete exclusion of the aneurysm sac. Thirty-day mortality occurred in one patient (2%). The 30-day morbidity rate was 20%, and was mostly associated with insufficiency of the pelvic circulation. One aneurysm-related death occurred during a mean follow-up period of 13 months (range 0.5–56 months). Open surgical intervention for aneurysm-related complications was required in five patients. In conclusion, endovascular treatment of isolated internal iliac artery aneurysms is an effective alternative option, with satisfactory early and mid-term results.
Collapse
Affiliation(s)
- George A Antoniou
- Vascular Institute, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Ahmed H Nassef
- Vascular Institute, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Stavros A Antoniou
- Department of General and Visceral Surgery, Krankenhaus ‘Maria v. d. Aposteln’ Neuwerk, Mönchengladbach, Germany
| | - Charles Yuen Yung Loh
- Vascular Institute, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Douglas R Turner
- Vascular Institute, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Jonathan D Beard
- Vascular Institute, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| |
Collapse
|
10
|
McFarlane MEC, Plummer J, Simpson L, Roberts P, Kirby X, Downes R, Antoine N. Internal iliac artery aneurysmo-colonic fistula: a rare presentation of massive lower gastrointestinal haemorrhage: report of a case. Eur Surg 2009. [DOI: 10.1007/s10353-009-0466-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
11
|
Secondary Arterioenteric Fistulation – A Systematic Literature Analysis. Eur J Vasc Endovasc Surg 2009; 37:31-42. [PMID: 19004648 DOI: 10.1016/j.ejvs.2008.09.023] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 09/30/2008] [Indexed: 11/21/2022]
|
12
|
Dix FP, Titi M, Al-Khaffaf H. The Isolated Internal Iliac Artery Aneurysm—A Review. Eur J Vasc Endovasc Surg 2005; 30:119-29. [PMID: 15939637 DOI: 10.1016/j.ejvs.2005.04.035] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2005] [Accepted: 04/29/2005] [Indexed: 11/21/2022]
Abstract
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.
Collapse
Affiliation(s)
- F P Dix
- Department of Vascular Surgery, Burnley General Hospital, Burnley, UK.
| | | | | |
Collapse
|