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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Giornale Italiano di Chirurgia Vascolare 1999 December;6(4):239-50
language: English, Italian
Aneurysms of the internal iliac artery. Indications for surgical treatment with tactical and technical notes
Ippoliti A., Di Giulio L., Pistolese G. R.
From the Vascular Surgery Department and Specialisation School “Tor Vergata” University, Rome, Italy
Background. The authors analyse the clinical presentation, diagnostic procedures and treatment of internal iliac artery aneurysms.
Methods. Of 729 patients undergoing aortoiliac aneurysm surgery between July 1990 and March 1999, 18 presented aneurysm of the internal iliac artery: 12 were associated with abdominal aortic aneurysm, while 6 were isolated, including one in a bilateral form. Two cases were symptomatic: one patient underwent emergency aneurysm repair following rupture, while another presented hydronephrosis. The mean age of patients was 67 years old; 16 males and 2 females. Patients selected for elective surgery underwent ultrasonographic, CT and angiographic controls. Proximal ligation was performed in 4 of the 12 patients with associated abdominal aortic aneurysm; aneurysmorrhaphy and suture of the emergent arterial branches were also performed in 8 patients; the internal iliac artery was revascularised more distally in one patient, and the inferior mesenteric artery was reimplanted in another. Of the 6 "isolated" cases, proximal and distal ligation was carried out in 2 patients with resection of the aneurysm; proximal suture and aneurysm reduction was performed in 2 cases; one case was treated with aneurysmorrhaphy and bypass grafting between the common and external iliac arteries. The patient presenting involvement of both internal iliac arteries underwent aneurysm resection on one side and covered iliac stenting after internal iliac artery embolisation on the contralateral artery.
Results. The operative mortality was 11.1% (2 cases): one patient died from myocardial infarction and another due to multiorgan failure after rupture. The patient with hydronephrosis recovered after the operation.
Conclusions. At follow-up (mean = 52 months), two patients had died from myocardial infarction 28 and 44 months after the operation.