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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2004 June;17(3):103-6
A case of aneurysmal rupture of the internal iliac artery. Diagnosis and treatment
The case of a patient suffering from ruptured internal iliac artery (IIA) is reported. Aneurysms of the IIA are extremely rare and are generally associated with aneurysms of the abdominal aorta (AAA) or occur subsequent to vascular substitution for AAA. They are generally observed in male subjects of advanced age. The case observed by us and reported here was in a young patient with ruptured isolated aneurysm of the right IIA simulating a picture of strangulated inguinal hernia. The patient was subjected to surgery with proximal and distal ligature of the artery and aneurysmectomy. Diagnosis is not always easy both because of the rarity of the condition and owing to the nonspecificity of the symptomatology. Diagnostic techniques such as echography and CT scan of the abdomen are employed. Aneurysms of the IIA present high morbility and mortality and this is related to the inevitable evolution towards rupture if they are not treated.
There is no close relationship between diameter of the aneurysm and the risk of rupture, as cases of rupture of small diameter IIA aneurysms have been observed. The classic therapeutic approach makes use of surgical treatment and this can vary from straightforward ligature of the IIA to proximal and distal ligature of the same and aneurysmectomy. Recently new therapeutic approaches have been proposed going from embolisation with substances such as cyanoacrylate to the use of vascular stents. Naturally, the choice of treatment will vary according to the clinical conditions of the patient, the diameter of the aneurysm and other parameters which are evaluated by the medical team as the need arises.