Bilateral ruptured isolated internal iliac artery aneurysms —Report of a case and review of the literature

We present herein, a rare case of a 78 year old man who experienced rupture of an isolated internal iliac artery aneurysm on 2 separate occasions. He underwent successful embolization with ligation of the right aneurysm at our institution, where only 2 such cases have ever been seen. Embolization with ligation proved very effective in clotting the intraaneurysmal blood in this case and would appear to be the treatment of choice for very large aneurysms. A review of the English and Japanese literature follows this case report.     

Isolated dissecting aneurysm of the common iliac artery: Report of a case

Isolated dissecting aneurysms of the peripheral arteries which are not accompanied by a dissecting aneurysm of the aorta are rarely observed. We report herein the unusual case of a 54-year-old man in whom an isolated common iliac aneurysm was found to be caused by isolated dissecting aneurysms of the left common iliac artery.     

Massive hematuria after cystoscopy in a patient with an internal iliac artery aneurysm.

An unusual case is reported here of a patient with internal iliac artery aneurysm who developed massive hematuria after cystoscopic examination. A 75-year-old man presented with asymptomatic gross hematuria. Cystoscopic examination revealed that the bladder neck was congested and that the right-side wall was being pressed on by an extrinsic mass. Computed tomography showed a right internal iliac artery aneurysm and tortuous perivesical vessels. Three days after the cystoscopic examination the patient suffered massive hematuria. Hemorrhage due to an arteriovesical or arterio-ureteral fistula secondary to rupture of the internal iliac artery aneurysm was suspected, and an emergency operation was performed. At operation the aneurysm had not ruptured but overswelling perivesical vessels were found to have developed, and these fed a high blood flow to the bladder neck. In the present case cystoscopic examination injured the mucosa and led to massive hemorrhage from the bladder neck.     

Delayed rupture of an internal iliac artery aneurysm following proximal ligation for abdominal aortic aneurysm repair

This is a report of a patient presenting with a contained rupture of an internal iliac aneurysm following proximal ligation after abdominal aortic aneurysm repair three years earlier. The patient presented with a large pelvic mass with symptoms of urgency, frequency, dysuria, tenesmus and fevers associated with anemia. Following evacuation of the aneurysm and direct suture ligation of the distal branches of the internal iliac artery, the patient's aortic graft was covered with omentum which also filled the pelvic cavity. The importance of proximal and distal control of aneurysms and/or the importance of complete luminal control of internal iliac artery aneurysms is emphasized by this case.     

Treatment of internal iliac artery aneurysms: single‐centre experience

Background: The aim of the present study was to analyse the short‐term results of treatment of internal iliac artery aneurysms (IIAA). Methods: In a prospective single‐centre cohort study all patients with IIAA (symptomatic or maximal diameter ≥30 mm) were evaluated for endovascular repair, which included coil embolization of the run‐off vessels and coverage of the orifice of the IIAA with a stent graft. Open repair was performed with aneurysm excision or aneurysmorrhaphy. Outcome criteria were technical and clinical success and complications of treatment. Results: In a period of 40 months 11 patients underwent operation for 12 IIAA. Nine aneurysms were repaired endovascularly and three with open repair. Coil embolization was routinely performed in all cases. At a median follow up of 18 months, technical and clinical success was 100%. Major complications included two early limb thromboses, a contrast‐agent‐induced nephropathy, and an intraoperative ureteric injury. Conclusion: Despite the limited number of patients, the present series, with good short‐term results, further supports the trend towards endovascular repair of suitable IIAA.     

An isolated aneurysm of the common iliac artery associated with an arterio-venous fistula: Autotransfusion technique and postoperative hemodynamic monitoring —A case report—

Isolated aneurysms of the common iliac artery occur less frequently than abdominal aortic aneurysms. Moreover, the rupture of an isolated iliac aneurysm into a systemic vein is considered to be very rare. The case reported herein is of a patient with a left common iliac aneurysm which ruptured into the iliac vein, who was successfully treated surgically, using Doty’s autotransfusion technique as a supportive measure. We describe our preoperative diagnosis, operative method, including the supportive measures, and the postoperative hemodynamic changes monitored by a Swan-Ganz catheter.     

Ruptured isolated external iliac artery true aneurysm associated with cystic medial necrosis: Report of a case

We report a case of a ruptured isolated true external iliac artery aneurysm (EIAA). A 78-year-old woman was admitted to our institution in a shock state after the sudden onset of severe pain in the right hypogastric region. A pulsating mass was found in her right lower abdomen. Computed tomography (CT) with contrast medium showed an isolated EIAA, 40 mm in diameter, with a massive retroperitoneal hematoma. She underwent emergency resection of the aneurysm and reconstruction of the affected artery, without any complications. Histological examination confirmed a true aneurysm caused by cystic medial necrosis (CMN). She had no ocular, cardiac, or orthopedic abnormalities. We review the literature on isolated true aneurysms of the external iliac artery, which are extremely rare, and discuss their clinical manifestations.     

Successful management of iliac mycotic aneurysm secondary to klebsiella endocarditis —Report of a case

A case of common iliac mycotic aneurysm that presumably developed secondary to Klebsiella endocarditis was described. Recently, reports on gram negative septicemia and endocarditis have been on the increase. However, mycotic aneurysms secondary to bacterial endocarditis and particularly to Klebsiella endocarditis are rare. Inadequately treated serious gram negative septicemias have a high mortality rate. Early diagnosis and adequate combination chemotherapy with prompt surgical intervention were proven to be important factors in the successful management of such a complication.     

Development of a fistula between an internal mammary artery graft and the pulmonary vasculature following coronary artery bypass grafting: Report of a case

We report herein the rare case of a 56-year-old man who gradually developed congestive cardiac failure 6 months after undergoing coronary artery bypass grafting and was found to have a fistula between the internal mammary artery and the pulmonary artery of the upper lobe diagnosed by selective left internal mammary arteriogram. A second sternotomy was performed and demonstrated dense adhesion between the fissure surrounding the internal mammary artery and the upper lobe, and the fistula was resected. We believe that the patient's increasing cardiac failure was almost certainly caused by coronary steal.     

The use of iliac branch devices for preservation of flow in internal iliac artery during endovascular aortic aneurysm repair

ObjectiveCommon iliac artery aneurysms are present in more than a third of patients with abdominal aortic aneurysm and may pose a challenge during open and endovascular repair. Although embolization of the internal iliac artery is an established method, it may be complicated with buttock claudication, erectile dysfunction, colon ischemia, and pelvic necrosis. Iliac branch devices (IBDs), which permit preservation of the hypogastric artery, have been used to prevent these complications. We conducted a meta-analysis to assess the safety and outcomes of IBDs and to explore potential differences between the commercially available types of IBDs.MethodsThe meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. After review of the literature, 36 eligible studies with a total of 1502 patients were included in our study. A meta-analysis was performed with investigation of the following outcomes: technical success rate, 30-day mortality, 30-day patency, follow-up patency, endoleak, buttock claudication, and IBD-associated reintervention. Furthermore, we conducted a subgroup meta-analysis by commercial type of endograft among the outcomes of interest.ResultsAmong all eligible studies, technical success of the method was 97.35% (95% confidence interval [CI], 96.27-98.29). The endoleak rate postoperatively and during the follow-up period was 12.68% (95% CI, 8.80-17.07). The 30-day patency of IBDs was estimated at 97.59% (95% CI, 96.49-98.54), whereas follow-up patency was 94.32% (95% CI, 91.70-96.54). Furthermore, reintervention rate associated with IBDs was 6.96% (95% CI, 5.10-9.03), and buttock claudication during the follow-up period was 2.15% (95% CI, 1.25-3.22).ConclusionsIBD seems to be a safe, feasible, and effective technique for the treatment of aortoiliac aneurysms in select patients with suitable anatomy. Further results are awaited to explore the long-term efficacy and durability of these devices.     

右侧髂窝移植肾失功合并同侧髂总动脉夹层动脉瘤及髂外静脉狭窄1例

正患者女,45岁,因慢性肾功能不全接受右侧髂窝肾移植术,术后4h血压进行性下降,给予多种大剂量血管活性药物后血压波动于30～50/20～40mmHg,心率130～150次/分,失血性休克,伴右下肢肿胀逐渐加重。急诊床旁超声:右侧髂窝移植肾大小正常,各级动脉血流树稀疏,可见三级动脉,频谱呈针状高速高阻型(图1A),移植肾静脉内未见明确血流信号(图1B),肾周血肿;右股动脉纤细,远端流速减低;右下肢深、浅静脉内径增宽,其内未见血流信号,未见明确血栓。     

The iliac bifurcation device for endovascular iliac aneurysm repair: indications,deployment options and results at 1‐year follow‐up of 25 cases

Background: The iliac bifurcation device (William A Cook Australia, Brisbane, QLD, Australia) is a new endovascular device for iliac aneurysm repair. We review the indications for use, device characteristics, deployment options and the results of our case series. Methods: The most common indication for deployment is endovascular aortic aneurysm repair (EVAR) with common iliac aneurysm repair. The standard deployment sequence can be adapted to increase the utility of the device. Data were collected prospectively. Follow‐up was performed with plain X‐ray, ultrasound and computed tomography (CT) scan. Results: Between 2004 and 2007, 25 patients had their common iliac artery aneurysm repaired using the iliac bifurcation device. There were 23 male and 2 female patients. Median age was 75 years (range 60–85). The median follow‐up was 12 months (range 1–38). Twenty‐one procedures were combined with EVAR. The median abdominal aortic aneurysm diameter was 60 mm (range 31–97), and the median common iliac artery aneurysm diameter was 37 mm (range 24–71). Technical success was achieved in 100% of cases. There were no acute branch vessel occlusions. There was one early type I endoleak (4%). There was one death (4%) in the 30‐day period post‐procedure. There was one late type I endoleak (4%). Conclusions: The iliac bifurcation device achieves endovascular common iliac artery aneurysm repair with preservation of internal iliac artery flow. There are multiple different applications of the device and complementary deployment techniques. High rates of technical success and low rates of branch vessel occlusion are possible.     

Atherosclerotic superficial temporal artery aneurysm: Report of a case

(Received for publication on Jan. 21, 1998; accepted on Nov. 6, 1998)     

Traumatic aneurysm of the internal carotid artery in an infant: a surprise diagnosis

Isolated aneurysm of the extracranial section of the internal carotid artery has been reported in children but never, to our knowledge, in an infant. It can represent a major anaesthetic challenge with compromise of both airway and cerebral perfusion and the associated risks of rupture. We report on an 11-month-old infant, who had undergone an examination under anaesthesia of her nose and throat for epistaxis and gastrointestinal endoscopy due to apparent gastrointestinal bleeding shortly before presenting to us with signs of rapidly progressive upper airway obstruction. Emergency examination under anaesthesia revealed a large pulsatile mass in the posterior nasopharynx which, on subsequent radiological investigation, was revealed to be a large pseudoaneurysm of the right internal carotid artery, obstructing distal flow. An apparently minor episode of trauma had occurred around the time of the first nosebleed; she had allegedly fallen onto her face with a spoon in her mouth.     

Successful simultaneous operation of concomitant early gastric cancer, transverse colon cancer, and a common iliac artery aneurysm

In an 83-year-old Japanese man, concomitant bleeding colon cancer, early gastric cancer, and an expanding right common iliac artery aneurysm were evident. The patient underwent an artificial graft implantation, partial gastrectomy, and transverse colectomy, simultaneously. To protect against graft infection, the aneurysm was resected first, and then the retroperitoneum was tightly closed to isolate the graft from the peritoneal cavity. The postoperative course was uneventful, except for symptoms of temporary delirium. Recently, simultaneous surgery for concomitant abdominal aortic aneurysms and early gastric cancer has been commonly performed in Japan because the contamination of the peritoneal cavity during a gastrectomy is thought to be less severe than that during lower abdominal surgery. However, the positive rate for bacterial culture in colorectal resections is virtually the same as that in gastrectomies. Moreover, the incidence of graft infection is substantially lower than the positive rate for bacterial culture in surgery for aneurysms. Some surgeons object to a simultaneous resection due to fear of graft infection, but even the presence of infectious organisms does not always result in graft infection. The present case illustrates the benefits of a simultaneous operation for both an aneurysm and gastrointestinal malignancy.     

Iatrogenic dissecting aneurysm of the internal carotid artery

Summary A secondary dissecting aneurysm after arterial injury has been reported as a complication of surgery. We encountered this phenomenon in a patient with a meningioma of the sphenoid ridge. Despite successful clipping of a small rupture in the anterior wall of the proximal portion of the internal carotid artery, the patient became drowsy 30 days after surgery and developed right hemiparesis followed by fatal bleeding from the internal carotid artery. Histological examination revealed a traumatic dissecting aneurysm which had developed from the tear in the intima and extended into the dural ring and the bifurcation of the carotid artery. The characteristic clinical and histopathologic findings are shown. Methods for early recognition and the possibility of immediate treatment are briefly discussed.     

Autogenous internal iliac artery bypass in the surgical treatment of renovascular hypertension: A case report

A 24 year old female with severe renovascular hypertension resulting from bilateral fibromuscular dysplasia was successfully treated surgically. The internal iliac artery was used for a left aortorenal grafts. The right renal artery was dilated through the amputated left renal stump. Although saphenous vein graft is most commonly used, the autogenous internal iliac artery is considered a satisfactory graft in aortorenal reconstruction, especially for a young patient.     

Ureteral obstruction due to retroperitoneal fibrosis secondary to a solitary internal iliac aneurysm

We report a case of ureteral obstruction due to retroperitoneal fibrosis secondary to a solitary left internal iliac aneurysm. It has been reported that as a cause of ureteral obstruction, an internal iliac aneurysm without aortic and/or common iliac aneurysms is very rare. In the present case, magnetic resonance imaging was a useful modality to diagnose retroperitoneal fibrosis secondary to an internal iliac aneurysm as a direct cause of ureteral obstruction.     

介入治疗无症状孤立性左侧髂外动脉夹层1例

正患者男,56岁,因"发现可疑左侧髂外动脉夹层5个月"入院;既往患慢性病毒性乙型肝炎,无外伤史。查体:左侧股动脉搏动强度较对侧稍弱,余未见明显异常。下肢动脉CTA:左侧髂外动脉起始段见9 mm×4 mm结节状突起,管腔内见充盈缺损,考虑左侧髂外动脉夹层并假腔内附壁血栓形成(图1A),腹主动脉未见其他异常。左侧髂总动脉造影:左侧髂外动脉起始段见囊袋状突起,由血管腔内突向腔外,长约10 mm(图1B)。临床诊断:左侧髂外动脉起始段夹层形成。行