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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 2003 October;44(5):647-53

lingua: Inglese

Aneurysms of the hypogastric artery following surgery of the abdominal aorta. A report of two cases and review of the literature

Rispoli P., Raso A. M., Varetto G., Moniaci D., Barile G., Maselli M., Conforti M.

Unit of Vas­cular Sur­gery, Depart­ment of ­Medico-Sur­gical Dis­ci­plines, Uni­ver­sity of ­Turin, ­Turin, ­Italy
Post­grad­uate ­School of Vas­cular Sur­gery, Mol­in­ette Hos­pital, ­Turin, ­Italy

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Iso­lated aneu­rysms of the hypo­gas­tric ­artery are ­very ­rare and ­account for ­between 0.04% and 0.4% of all ­intra-abdom­inal aneu­rysms. In 85% of ­cases ­they are mono­lat­eral and are ­present in asso­ci­a­tion ­with an aneu­rysm of the infra­renal abdom­inal ­aorta and of the ­common and ­external ­iliac ­arteries, ­they ­make up ­part of a ­poly-aneu­rysmal dis­ease. ­Unless the ­patient is an ­extremely ­poor con­di­tion, sur­gical treat­ment is gen­er­ally indi­cated for aneu­rysms ­greater ­than 3 cm; ­close mon­i­toring of ­those ­with ­smaller aneu­rysms is rec­om­mended. Two ­patients pre­sented ­with iso­lated aneu­rysm of an ­internal ­iliac ­artery ­which had devel­oped sev­eral ­years ­after aor­toi­liac sur­gery. The one ­received sur­gical treat­ment; the ­other, who was in ­poor gen­eral con­di­tions and at ­high ­risk for sur­gery, under­went endo­vas­cular embol­iza­tion. ­Both pro­ce­dures ­were suc­cessful, ­with a cur­rent ­follow-up ­between 15 and 18 ­months. Endo­vas­cular embol­iza­tion, as per­formed in the ­2nd ­patient, pro­vided an alter­na­tive to the sur­gical pro­ce­dure. ­After injec­tion in the aneu­rysmal sac of the Gian­turco spi­rals, a cov­ered ­stent was ­placed in the ­iliac ­axis to ­exclude the ­inflow of the hypo­gas­tric ­artery. ­According to our expe­ri­ence of 2 ­patients, the one ­treated sur­gi­cally and the ­other sub­mitted to a ­less inva­sive endo­vas­cular pro­ce­dure, we can ­state ­that ­both ­methods are prac­ti­cable. The ­final ­choice ­lies ­with the vas­cular sur­geon,­ after ­weighing the mul­tiple fac­tors ­that ­each ­case ­involves.

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