Signs of impending rupture in abdominal aortic and iliac artery aneurysms by computed tomography: Outcomes in 41 patients

OBJECTIVES: This study aimed to determine the prevalence of signs of impending rupture (SIR) in asymptomatic patients with abdominal aortic and iliac artery aneurysms, and to evaluate whether these signs were associated with rupture in asymptomatic patients. METHODS: This was a retrospective study of patients with abdominal aortic and iliac artery aneurysms identified on computed tomography (CT) over a 10-year period in a single center. The CT scans were reviewed by two reviewers, and patients with SIR were assigned to one of three groups: (1) early symptomatic (ES), (2) late symptomatic (LS), and (3) always asymptomatic (AA). The four main SIR described in the literature were investigated: 1) crescent sign, 2) focal wall discontinuity of circumferential calcifications, 3) aortic bulges or blebs, and 4) aortic draping. RESULTS: From a total of 759 aortic and iliac aneurysm reports on 2226 CT scans, we identified 41 patients with at least one SIR, and a prevalence of 4.14% in asymptomatic patients. Focal wall discontinuity of circumferential calcifications was the most common sign, and it was present in 46.3% of these patients (19/41); among these, 26 were repaired (ES: 9, LS: 2, AA: 15). Eleven asymptomatic patients underwent follow-up CT. The aneurysm increased in size in 6 of the 11 (54.5%) patients, and three ruptured (all with discontinuity of calcifications), one of which had no increase in diameter. CONCLUSIONS: The presence of focal wall discontinuity of circumferential calcifications was the most common SIR. There was a prevalence of all signs in less than 5% of asymptomatic patients. In unrepaired patients, the signs could be observed on follow-up CT scans with an increase in aneurysm size, indicating that the presence of SIR alone in the absence of other clinical factors or aneurysm characteristics is an insufficient indication for surgery.

Reparación endovascular de aneurisma de arteria ilíaca común asociado a fístula arterio-venosa ílio-ilíaca: reporte de caso / Endovascular repair of common iliac artery aneurysm associated with ilio-iliac arteriovenous fistula: case report

Resumen Introducción: Los aneurismas aislados de arteria ilíaca común son una patología infrecuente y habitualmente el diagnóstico es incidental. Su manejo solía ser por vía abierta, pero con el advenimiento de la cirugía endovascular, se han identificado mejores desenlaces en los pacientes llevados a este tipo de procedimientos, reservando la reparación abierta en los casos agudos y rupturas. La asociación entre estos aneurismas con fístulas ílio-ilíacas son infrecuentes y su manejo endovascular se ha reportado en solo una ocasión. Objetivo: Se presenta un caso de un paciente masculino de 82 años, con esta asociación, en el cual se decidió llevar de manera electiva a manejo endovascular de su patología. Discusión: En la literatura el manejo endovascular es ampliamente recomendado por su perfil de seguridad, sin embargo, no existe suficiente evidencia ante la presencia de una fístula ílio-ilíaca de manera concomitante, por ser una condición infrecuente. Conclusión: En el presente caso, abordamos de manera endovascular esta relación, obteniendo resultados favorables, con adecuado control de la patología, sin presentación de complicaciones.

Introduction: The isolated aneurysms of the common iliac artery correspond to an infrequent pathology; and the diagnosis of this entity is usually incidental. Its management is usually by open route, but with the advent of endovascular surgery, better outcomes have been identified in patients taken to this kind of procedure, reserving open repair for the urgent cases, like ruptures. The association between these aneurysms with ilio-iliac fistula is uncommon and their endovascular management has been reported only in one case in the literature. Aim: A case of an 82-year-old male patient will be presented, with this association, who was taken to an endovascular repair of his pathology, with good postoperative results. Discussion: In the literature, endovascular management is recommended by its safety profile, however there is insufficient evidence in the presence of an ilio-iliac fistula concomitantly, because it is an infrequent condition. Conclusion: In the present case, we address this relationship endovascularly, obtaining favorable results, with adequate control of the pathology, without presenting any complications.

Aneurisma gigante de arteria iliaca interna roto / Giant ruptured internal iliac aneurysm

Objetivo: Presentar un caso infrecuente de aneurisma gigante de arteria iliaca interna roto. Caso clínico: Varón de 68 años de edad con antecedentes de hipertensión arterial crónica, dislipidemia, cardiopatía valvular, cor pulmonale con hipertensión pulmonar moderada, portador de marcapasos definitivo, obesidad y alergia a la plata. Ingresa de urgencia por dolor brusco en fosa iliaca izquierda, irradiado periumbilicalmente sin cortejo vegetativo. En el TC abdominal se objetiva la presencia de un aneurisma gigante de la arteria hipogástrica izquierda con diámetro de 6,8 cm y signos de rotura. Se realiza de forma urgente cirugía endovascular mediante implante de prótesis Endurant® y embolización de arterias glúteas con Coils Interlock®. Control al mes y a los 6 meses sin endofugas ni crecimiento del saco. Discusión: El tratamiento de elección de los aneurismas iliacos sigue siendo la cirugía, de forma electiva cuando el diámetro de la arteria es mayor de 3 cm y urgente cuando debutan con rotura. La terapia endovascular es una alternativa segura y eficaz a la cirugía convencional, con resultados satisfactorios a corto y medio plazo.

Aim: To present an infrequent broken giant Iliac artery aneurysms. Case report: In the current study, we report a case of a 68-year-old male patient with chronic high blood pressure, cholesterol, valvular heart disease, cor pulmonale, pacemaker, obesity and silver allergic. He presented sudden onset of abdominal pain. Computed tomography (CT) revealed a large ruptured left hypogastric aneurysm (diameter of 6.8 cm). Hypogastric aneurysm was repaired by an endovascular graft repair: Endurant® endogratf and coils embolization of gluteal arteries (Interlock®). The patient had a satisfactory clinical progression and recovery. At one and six months after the operation TC revealed not Type II endoleaks. Discussion: Isolated aneurysms of the iliac arteries are rare. Surgical treatment is recommended for iliac artery aneurysms larger than 3 cm. Endovascular repair is an attractive method to repair isolated iliac artery aneurysms with lower morbidity and mortality rates than open surgery.