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Giornale Italiano di Chirurgia Vascolare 1999 December;6(4):239-50

Copyright © 2000 EDIZIONI MINERVA MEDICA

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


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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.

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