Endovascular Repair of a Common Iliac Artery Aneurysm and Arteriovenous Fistula with Congestive Heart Failure / 日本心臓血管外科学会雑誌

<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^® 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>

Change of Common Iliac Artery after Abdominal Aortic Aneurysm Repair Using a Tube Graft / 대한혈관외과학회지

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.

Isolated Aneurysm of the Left Common Iliac Artery that was Secondary to Medial Degeneration

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.