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.

Aneurismas ilíacos / Iliac aneurysms

Los aneurismas ilíacos puros constituyen una patología poco frecuente y muchas veces oculta por su sintomatología variada y su difícil palpación. Se presentan 6 aneurismas ilíacos puros operados en 4 pacientes, entre los años 1974 y 1988, encontrándose una incidencia del 3 por ciento sobre el total de aneurismas intraabdominales operados en el mismo período. Se trataba de aneurismas de ilíaca primitiva bilateral en 2 pacientes y unilateral en los restantes. El diámetro varió entre 3,5 y 9 cm, presentándose el más grande de ellos con ruptura y shock hipovolémico. Se considera la tomografía axial computada como procedimiento ideal no sólo para el diagnóstico sino también para planificar la cirugía electiva. En todos los casos los pacientes fueron tratados mediante reemplazo endoaneurismático o exclusión con prótesis de Dacron tratando de conservar la permeabilidad del sistema hipogástrico-ilíaca externa-femoral profunda homolateral