ABSTRACT
Abstract Isolated external iliac artery aneurysm is a rare occurrence. These aneurysms have varied presentations depending on size and proximity. Both open surgical and endovascular modalities can be used for treatment depending upon presentation, aneurysmal anatomy, and patient condition. Preservation of at least one internal iliac artery is important to prevent post-repair hypogastric ischemia. There are no previous reports of IgG4-related disease (IgG4-RD) as etiology of these aneurysms. A 32-year-old male patient presented with a left lower abdominal lump and was found to have a left external iliac artery aneurysm on computed tomography angiography. The patient underwent iliofemoral bypass with an 8 mm polyester graft. Histopathological examination of the aneurysm wall suggested IgG4-RD. The patient fulfilled the 2020 Revised Comprehensive Diagnostic Criteria for IgG4-RD. An 18-Fluorodeoxyglucose-Positron Emission Tomography scan performed in the postoperative period showed no active disease, hence medical therapy was not instituted. The patient is doing well at 1 year.
Resumo O aneurisma isolado da artéria ilíaca externa é uma ocorrência rara. Esses aneurismas têm apresentações variadas, dependendo do tamanho e da proximidade. Ambas as modalidades cirúrgicas aberta e endovascular podem ser usadas para o tratamento, dependendo da apresentação, anatomia do aneurisma e condição do paciente. A preservação de pelo menos uma artéria ilíaca interna é importante para prevenir isquemia hipogástrica pós-reparação. A doença relacionada à imunoglobulina G4 (IgG4-RD) nunca havia sido encontrada como etiologia desse aneurisma. Um paciente do sexo masculino de 32 anos que apresentava um nódulo no abdome inferior esquerdo foi diagnosticado com aneurisma da artéria ilíaca externa esquerda na angiotomografia computadorizada. O paciente foi submetido a bypass iliofemoral com enxerto de poliéster de 8 mm. O exame histopatológico da parede do aneurisma era indicativo de IgG4-RD. O paciente cumpriu os Critérios Abrangentes Revisados para IgG4-RD de 2020. A tomografia por emissão de pósitrons com 18-fluorodesoxiglicose no pós-operatório não evidenciou doença ativa, não sendo instituída terapia medicamentosa. Após seguimento de 1 ano, o paciente está bem.
ABSTRACT
<p>We report a case of endovascular surgery in a patient of common iliac artery aneurysm with arteriovenous (A-V) fistula. A 60-year-old woman was admitted because of dyspnea. She had a clinical history of lumbar disk surgery at age of 40. On physical examination, we detected a pulsatile mass and pansystolic murmurs in her left lower abdomen. A chest X-ray film demonstrated severe cardiomegaly with 70% of cardiothoracic ratio. Contrast-enhanced CT revealed left common artery aneurysm with A-V fistula between the left common iliac artery and the left common iliac vein. Three-dimensional CT showed hyper-vascularity in the region from the pelvic vein to IVC. We considered that she had high risk of intraoperative massive bleeding for open abdominal surgery. We conducted endovascular repair for this iliac artery aneurysm with A-V fistula by the GORE EXCLUDER C3<sup>®</sup> stent graft system. Postoperative contrast-enhanced CT showed complete exclusion of both left common iliac artery aneurysm and A-V fistula. After surgery, her symptoms improved significantly.</p>
ABSTRACT
A 65-year-old male with medical history of hyperlipidemia, type 2 diabetes mellitus, and arterial hypertension well controlled by glibenclamide, and amlodipine plus enalapril for about a decade was referred to our service because of the recent fndings in aortography (Figure 1: A, B, and C). He was not a smoker, neither a heavy alcohol drinker, and had chronic lumbar pain related to degenerative spondyloarthropathy. Previous imaging studies had showed narrowing of the disc space and reduction of the diameter of spinal canal on L4 and L5. During evaluation of control, an incidental image was observed in the right side of his pelvis, and the aortography was done. On presentation, BMI was 33 kg/m2, temperature was 36°C, blood pressure was 120x80 mmHg, with 80 bpm and 14 irpm, and there were no signifcant physical fndings on abdominal region. Laboratory fndings (normal ranges) revealed unremarkable blood counts and thyroid function; total cholesterol 289 (<200 mg/dL), HDL 54 (30-60 mg/ dL), LDL 206 (100-190 mg/dL), and tryglicerides 147 (<180 mg/dL); glucose 70 (70-99 mg/dL), uric acid 8.7 (2.5-7.0 mg/dL), urea 57 (14-50 mg/dL) with creatinine clearance 129.6 (≥129 ml/min); and PSA 0.5 (<4.0 ng/mL). After a successful open invasive procedure, he was discharged to outpatient.
Varón de 65 años con antecedentes médicos de hiperlipidemia, diabetes tipo 2. mellitus, e hipertensión arterial bien controlada por glibenclamida, y Amlodipine plus enalapril durante aproximadamente una década se refirió a nuestro servicio debido a los hallazgos recientes en aortografía (Figura 1: A, B y C). No era un fumador, ni un gran bebedor de alcohol, y tenía Dolor lumbar relacionado con espondiloartropatía degenerativa. Anterior Los estudios de imagen han mostrado estrechamiento del espacio discal y reducción. del diámetro del canal espinal en L4 y L5. Durante la evaluación del control, se observó una imagen incidental en el lado derecho de su pelvis, y la Se realizó una aortografía. En la presentación, el IMC fue de 33 kg / m2, temperatura. fue de 36 ° C, la presión arterial fue de 120x80 mmHg, con 80 bpm y 14 irpm, y no hubo hallazgos físicos significativos en la región abdominal. Los hallazgos de laboratorio (rangos normales) revelaron recuentos sanguíneos sin complicaciones y la función tiroidea; colesterol total 289 (<200 mg / dL), HDL 54 (30-60 mg / dL), LDL 206 (100-190 mg / dL) y tryglicerides 147 (<180 mg / dL); glucosa 70 (70-99 mg / dL), ácido úrico 8.7 (2.5-7.0 mg / dL), urea 57 (14-50 mg / dL) con aclaramiento de creatinina 129.6 (≥129 ml / min); y PSA 0.5 (<4.0 ng / mL). Después un procedimiento invasivo abierto exitoso, fue dado de alta como paciente ambulatorio
Subject(s)
Humans , Male , Aged , Aortography , Iliac Artery , Aneurysm , Pain , Lumbosacral RegionABSTRACT
We report a case of left internal iliac aneurysm that ruptured into the left common iliac vein and formed an arteriovenous fistula. A 79-year-old man who had general fatigue was admitted to our hospital with a diagnosis of left internal iliac artery aneurysm, left hydronephrosis, dehydration and low renal function. After dehydration and low renal function resolved rapidly by medical treatment, an enhanced computed tomography was performed. This demonstrated a 69 by 67 mm diameter left internal iliac artery aneurysm with an arteriovenous fistula. During the operation, left common iliac artery and left external iliac artery were resected and the stumps sutured. External iliac-external iliac artery bypass was performed. An occlusive balloon catheter was inserted from the left femoral vein and the balloon was dilated to patch the fistula before opening the aneurysm. After clamping the proximal artery the aneurysm was opened. Bleeding from the fistula was controlled by this maneuver and digital compression of the left common iliac vein where was proximal side of fistula. An arteriovenous fistula with a 18 by 3 mm orifice was found between the left internal iliac artery and left common iliac vein. The fistula was closed from the inside of the aneurysm. His postoperative course was uneventful.
ABSTRACT
PURPOSE: It remains controversial whether to use a tube graft or a bifurcated graft during open abdominal aortic aneurysm (AAA) repair, due to the potential for progression or development of a common iliac artery (CIA) aneurysm. This study evaluated the fate of CIA after tubular AAA repair. METHODS: On a retrospective basis, we reviewed 61 patients who underwent open AAA repair with a tube graft, between March 2000 and December 2009. Fifty-seven patients were included in this study; we excluded 4 cases in which the patients died in-hospital. Of those enrolled, 24 patients underwent follow-up computed tomography at least 1-year after surgery. CIAs were categorized into 3 groups: normal (< or =12 mm), ectasia (range, 13 to 18 mm), and aneurysm (range, 19 to 25 mm). The incidence of CIA aneurysm rupture was investigated, and the expansion rate of CIA was calculated. RESULTS: Mean patient age was 64 years and 73% of patients were male. Preoperatively, 8 patients had 2 normal CIAs, 14 patients had one CIA aneurysm at least, 27 patients had one CIA ectasia, and 8 patients were unknown. There was a mean follow-up of 51 months; no deaths were caused by rupture of CIA aneurysm, and no patient underwent invasive treatment for a CIA aneurysm. The mean follow-up for 24 patients with 48 CIAs was 45 months. The mean expansion rate of CIA was 0.5 mm/y. CONCLUSION: AAA repair using a tube graft was a safe and durable procedure. However, a bifurcated graft should be considered when patients are young and there is the expectation of a long life expectancy is anticipated allowing for a CIA expansion rate of 0.5 mm/y.
Subject(s)
Humans , Male , Aneurysm , Aortic Aneurysm, Abdominal , Dilatation, Pathologic , Follow-Up Studies , Iliac Artery , Incidence , Life Expectancy , Retrospective Studies , Rupture , TransplantsABSTRACT
The patient, a 80-year-old man, had undergone aneurysmectomy and graft replacement of the right external iliac artery aneurysm and coil embolization and exclusion of the right internal iliac artery aneurysm in 2007. Computed tomography showed a rupture of the right internal iliac artery aneurysm in 2010. We performed aneurysmectomy and occlusion of the gluteal artery. The patient had a satisfactory postoperative course.
ABSTRACT
To report endovascular occlusion of an internal iliac artery aneurysm (IIAA) of two patients using Amplatzer vascular plug (AVP; AGA Medical Corporation, USA). A 69-year-old asymptomatic man had aneurysms of both internal iliac arteries. The size of the right (Rt) IIAA was 23 mm and that of the left (Lt) IIAA was 45 mm. We decided to induce vascular occlusion of the Lt internal iliac artery (IIA). We deployed an AVP in the proximal and distal Lt IIA. The patient was discharged after four days and showed no recurrence of aneurysm for one year. A 78-year-old women had lower abdominal pain for three days. Computed tomography scan showed a 43 mm Rt common iliac artery (CIA) aneurysm and a 38 mm Rt IIAA. We decided to insert a stent graft in the Rt CIA and to occlude the Rt IIA using AVP. We deployed the stent graft in the Rt CIA and the AVP in the distal Rt IIA. The patient was discharged after seven days and demonstrated no recurrence of aneurysm for four months. AVP is a feasible vascular occlusive device for internal iliac artery aneurysm.
Subject(s)
Aged , Female , Humans , Abdominal Pain , Aneurysm , Iliac Artery , Recurrence , Stents , TransplantsABSTRACT
A 90-year-old man was referred to our hospital for lower abdominal pain and ecchymotic discoloration around the anus. A laboratory test revealed severe anemia (hemoglobin level, 5.7 g/dl), and computed tomography (CT) showed a ruptured left internal iliac artery aneurysm (diameter, 60×44 mm). Consequently, emergency endovascular stent-grafting treatment was performed. Under local anesthesia, the stent-graft was successfully inserted in the left common and external iliac arteries, covering the ostia of the internal iliac artery. A follow-up CT scan showed complete thrombosis of the left internal iliac artery aneurysm and no evidence of an endoleak. After the procedure, the patient was treated with hemodialysis for acute-on-chronic renal failure and was discharged after 2 months.
ABSTRACT
Isolated aneurysm of the common iliac artery that is secondary to medial degeneration (MD) is a very rare clinical entity. MD is an important histological abnormality that is commonly seen in the annuloaortic ectasia with Marfan syndrome. This abnormality is also observed in congenital aortic disease, atherosclerosis, and aging. This aortic disease develops as the consequences of disruption of the medial elastic layers in association with loss of vascular smooth muscle cells and the accumulation of proteoglycans. An iliac aneurysm greater than 3 cm in diameter should be treated. The treatment options include open surgical replacement with prosthetic graft or endovascular stent grafting. We experienced one case of the isolated common iliac artery aneurysm in a 60 year-old female patient. Her chief complaint was a pulsatile painful mass in the left lower quadrant of the abdomen that she had suffered with for 5 days. She was treated by performing aorto-left external iliac artery bypass with a Dacron graft (10 mm in diameter). The result was excellent. We report here on a case of a isolated common iliac artery aneurysm that was caused by MD, and we include a review of the relevant literature.
Subject(s)
Female , Humans , Middle Aged , Abdomen , Aging , Aneurysm , Aortic Diseases , Atherosclerosis , Blood Vessel Prosthesis , Dilatation, Pathologic , Iliac Aneurysm , Iliac Artery , Marfan Syndrome , Muscle, Smooth, Vascular , Polyethylene Terephthalates , Proteoglycans , TransplantsABSTRACT
This report describes the open surgical or endovascular treatment of two patients with bilateral internal iliac artery aneurysms (IIAA). To prevent pelvic ischemia, complete aneurysmal resection and pelvic revascularization with an interposition graft was performed in the open surgical case. Endovascular repair including coil embolization of IIAA and stent-graft placement in the common iliac artery was done successfully in the other case. The contralateral IIAA was left undisturbed and followed for 36 months with no change in size. Prevention of pelvic ischemia is important in the simultaneous treatment of bilateral IIAA.
Subject(s)
Humans , Aneurysm , Embolization, Therapeutic , Iliac Aneurysm , Iliac Artery , Ischemia , TransplantsABSTRACT
Iliac artery aneurysm is rare disease. We report a 60-year-old man who was referred to our hospital because of right hydronephrosis and pelvic mass. A intravenous pyelogram, a computerized tomography scan and a magnetic resonance imaging revealed a pelvic sarcoma. We experienced a case of right internal iliac artery aneurysm masquerading as pelvic sarcoma.