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A Journal on Vascular and Endovascular Surgery

Official Journal of the Italian Society of Vascular and Endovascular Surgery
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Giornale Italiano di Chirurgia Vascolare 2001 March;8(1):43-51

language: English, Italian

Conventional and endovascular surgical treatment of iliac artery aneurysms

Nano G., Mainente A., Tealdi D. G.

Milan University “San Donato” Polyclinic Faculty and Department of Vascular Surgery (Director: Prof. D. G. Tealdi)


Background. The ­paper ­reports a ret­ro­spec­tive ­study ­designed to ­assess the fea­sibil­ity of an endo­vas­cu­lar ­approach as an ­adjunct to con­ven­tion­al sur­gi­cal treat­ment of ­iliac aneu­rysms.
Methods. In ­response to the ­life-threat­en­ing ten­den­cy to rup­ture of ­iliac aneu­rysms ­over 3-3.5 cm in diam­e­ter, 58 ­patients ­were giv­en tra­di­tion­al sur­gery in 1979-96 and lat­er (1997 - June 1999) in a sec­ond ­group of 16 ­patients, ­half (8) ­were giv­en con­ven­tion­al and 8 endo­vas­cu­lar sur­gi­cal treat­ment.
Results. Of the ­total num­ber of 66 con­ven­tion­al­ly treat­ed ­patients, no sig­nif­i­cant dif­fer­enc­es in sur­gi­cal tech­nique or ­results and no hos­pi­tal ­deaths ­were iden­ti­fied. Complications includ­ed two occlu­sions of the treat­ed ­area ­which ­were ­resolved by throm­bec­to­my, two ­delayed revas­cu­lar­isa­tions and one ­case of lym­phor­rhea ­from the ingui­nal inci­sion. Of the 8 ­patients giv­en endo­vas­cu­lar sur­gery, a key­hole ­approach was ­employed in 5 cas­es and the femo­ral ­artery had to be ­exposed in two oth­er cas­es: one ­that demand­ed simul­ta­ne­ous revas­cu­lar­isa­tion of the periph­er­al cir­cu­la­tion and the oth­er involv­ing the use of a par­tic­u­lar­ly ­wide endo­vas­cu­lar ­device. A nit­i­nol-cov­ered ­stent was ­used on all ­these ­patients and fol­low-up var­ied ­from 6 to 24 ­months. In 7 cas­es the exclu­sion of the aneu­rysm was instan­ta­ne­ous. In the one ­case of endo­leak ­caused by ­reflux ­from the hypo­gas­tric ­artery, a CT ­scan ­four ­months lat­er ­revealed spon­ta­ne­ous throm­bisa­tion of the aneu­rys­mat­ic sac ­that had elim­i­nat­ed the leak­age. In the one ­patient requir­ing iso­la­tion of the hypo­gas­tric ­artery, glu­teal claud­i­ca­tion devel­oped but ­regressed spon­ta­ne­ous­ly ­over a 3-­month peri­od. There ­were no post­op­er­a­tive com­pli­ca­tions of any ­kind.
Conclusions. It was there­fore con­clud­ed ­that ­while con­ven­tion­al sur­gery ­remains the treat­ment of ­choice for ­iliac aneu­rysms, the endo­vas­cu­lar ­approach is a val­id alter­na­tive in the ­right clin­i­cal and mor­pho­log­i­cal con­di­tions.

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