Rupture of internal iliac artery aneurysms
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Rupture of Internal Iliac Artery Aneurysms Case Report - Review I. Kotsikoris, A. Katsarou, S. Mylona, T. T. Papas, D. Maras, P. Pavlidis, N. Bessias Received 28/06/2012 Accepted 05/08/2012
Abstract
Introduction
Aim-Background: An isolated aneurysm of the internal iliac artery is rare, but rupture has a high mortality rate, making it thus a challenging clinical entity in need of special attention as to its immediate diagnosis and treatment. Methods: We present a case of ruptured isolated aneurysm of the internal iliac artery, as well as a literature review of relevant publications focusing on ruptured internal iliac artery aneurysms since 1990. Results: Out of a total of 43 cases with ruptured internal iliac artery aneurysm, 37 were isolated internal iliac artery aneurysms, while in 6 cases repair of abdominal aortic aneurysm (AAA) had preceded. Abdominal pain was the most common symptom and computed tomography (CT) was the diagnostic tool in all. A rupture into another organ was reported in 10 (23%) cases; into the urinary tract (urinary bladder or ureter) in 5 (11.5%) patients, bowel in 3 (7%), and inferior vena cava in 1 (2.3%) patient. The treatment was open surgery in 18/43 cases (42%), endovascular repair in 22/43 (51%), a combination of the two methods in 2/43 (4.6%), while in one case (2.3%), there was no information regarding treatment. Death occurred in 6/43 patients (14%), 3 of whom (7%) were treated with open surgery and 3 (7%) with endovascular means. Conclusions: Immediate diagnosis and treatment lead to good results, as concerns both open and endovascular repair of ruptured aneurysms of the internal iliac artery. A fundamental prerequisite is close cooperation between vascular surgeons and radiologists.
The isolated internal iliac artery aneurysm is a rare but severe condition, with an incidence of 0.4% and prevalence of 0.03% [1,2]. These aneurysms appear to have a greater tendency for rupture, compared to other artery aneurysms; reported data estimate the incidence of rupture at about 33% [1,2,3]. According to the literature, rupture of the internal iliac artery appears to carry a high mortality rate ranging between 33% and 60%, which seems to depend on early diagnosis and aggressive management [1,3]. Herein, we present the case of a patient with an isolated internal iliac aneurysm, in which direct diagnosis and management resulted in the patient’s survival; we also performed a literature review of relevant publications, focusing on ruptured internal iliac artery aneurysms (RIIAA) diagnosis and management.
Key words:
Aneurysms, Internal Iliac, Rupture
I. Kotsikoris (Corresponding author), D. Maras, P. Pavlidis, T. T Papas, N. Bessias - Department of Vascular Surgery, Red Cross Hospital, Athens, Greece A. Katsarou, S. Mylona - Department of Radiology, Red Cross Hospital, Athens, Greece e-mail: [email protected]
Case presentation Written informed consent has been obtained from the patient. A 69-year-old man presented to the emergency room of our hospital with severe acute abdominal pain l
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