Failure of exclusion of internal iliac artery aneurysms

Abstract

The exclusion of IIA aneurysm did not reliably result in thrombosis of the aneurysm. For IIA aneurysms extending deeply into the pelvis, even if the size of the aneurysm is smaller than 3.0 cm, the exclusion procedure should not be performed.

Internal iliac artery aneurysmo-colonic fistula: a rare presentation of massive lower gastrointestinal haemorrhage: report of a case

“…More recently, with the increased use of endovascular surgical techniques iliac aneurysms have been managed successfully without the need for open elective surgical repair. Proximal ligation or exclusion alone is ineffective in the treatment of these aneurysms and ultimately in preventing rupture [12]. It has been shown that thrombosed aneurysms occurring spontaneously or surgically induced still have the potential for rupture since the presence of the thrombus within the aneurysm did not lower the mean arterial pressure transmitted to the arterial wall [13].…”

State of the art: Management of iliac artery aneurysmal disease

“…In the presence of bilateral internal iliac artery occlusions, the adequacy of the inferior mesenteric artery (IMA) may be assessed intraoperatively by measuring the stump pressure. Reconstruction of the IMA, when the stump pressure index (IMA pressure/radial artery pressure) is less than 0.6, helps prevent postoperative ischemic colitis [16].…”

“…Operative treatment of patients with an isolated internal iliac artery aneurysm may consist of proximal ligation only, proximal plus distal ligation, aneurysmectomy with graft interposition, or endoaneurysmorrhaphy [15, 16]. Proximal ligation may be considered when the aneurysm is located deep in the pelvis, during repair of a ruptured common iliac artery aneurysm, if the aneurysm is densely adherent to pelvic organs, or in the presence of severe calcification.…”

“…Small (<3 cm) aneurysms in the proximal internal iliac artery regress in over 90% of patients, provided that the aneurysm sac has thrombosed completely. In contrast, patients with larger aneurysms located deep in the pelvis, who had persistent residual flow in the aneurysm sac, showed no change in sac size at midterm follow‐up [16]. Failure of sac regression suggests that the aneurysm remains pressurized and mandates closer surveillance to reduce the risk of late rupture.…”

Ruptur eines Aneurysmas der Arteria iliaca interna

“…Die ledigliche Ligatur oder Übernähung der Arteria iliaca interna am Abgang mit Belassen des möglicher-weise weiterhin über Seitenäste perfundierten Aneurysmas stellt keine sichere Sanierung dar, sekundäre Rupturen sind in der Literatur beschrieben [8,12]. Auf eine vollständige Resektion des Aneurysmasacks sollte wegen der Gefahr einer Venenverletzung verzichtet werden.…”