This case report describes a 69-year-old male patient who presented with an isolated right common iliac artery aneurysm measuring 8 cm in diameter. During pre-operative workup for planned open surgical repair, the patient's condition deteriorated and imaging showed rupture of the aneurysm. The patient underwent an emergency retroperitoneal surgical procedure to ligate the right iliac artery, perform an extra-anatomic femorofemoral bypass, and repair the ruptured aneurysm. Post-operatively, the patient recovered well with all pulses intact. Isolated iliac artery aneurysms are rare but can rupture with high mortality if not repaired. Both open surgical and endovascular techniques are used for treatment.

1. CASE REPORTS
Isolated aneurysm of the iliac artery, Surgery Department
Vascular (link to view this information.)
Isolated aneurysm of iliac artery
(Case report)
AUTHORS:
* Dr. John Benalcázar Freire.
ABSTRACT INTRODUCTION
Iliac aneurysms are a rare disease, Aneurysms isolated iliac artery
usually the etiological cause without an abdominal aortic
degeneration of the arterial wall aneurysm (AAA) associated, are
(atherosclerosis), growth is rare. Isolated aneurysms of the iliac
unfortunately silent about what is artery with a prevalence of 0.3% and
required for an adequate diagnosis and represent only 0.6% of aortoiliac
physical examination when it is aneurysms.
symptomatic symptoms are
gastrointestinal, urologic and / or Their location makes the diagnosis and,
gynecologic, the larger the aneurysm for this reason, until failure
the greater the risk of rupture and the asymptomatic for, which is associated
risk of death for the patient. To confirm with high mortality, greater than aortic
you must first apply an echo abdomino- aneurysms.
pelvic and if this be positive the next
step is to apply for CAT and / or Its incidence is estimated at 70 per
angiotomografí. 100,000 inhabitants / year in men aged
Iliac aneurysm should be resolved as between 65 and 75 years, and for
soon as possible by the imminent risk women in the same age group of 2 per
of rupture, endovascular technique 100,000 inhabitants / year. As in
when is the best indication even when abdominal aortic aneurysms its
the patient is in poor condition or had incidence increases with age, being
associated disease, the prognosis is rare under age 65.
better when performing a surgical
procedure scheduled that when The common iliac artery is affected
performing emergency. When an more often (70 to 90%), followed by
aneurysm ruptures patient mortality the internal iliac (10 to 30%), being
increases, therefore the conventional generally respected the external
surgical treatment is the best measure. iliac, for unknown reasons. There is
a clear male predominance
KEYWORDS: iliac aneurysm, (Gender ratio of 5:1 to 16:1), and the
atherosclerosis, ruptured aneurysm. majority of patients in surgical series
contents are 65 to 75 years.
Approximately 50% are bilateral.

2. The most common cause of these between the size and the breakdown
aneurysms is atherosclerosis, although was not clearly established.
other etiologies have been reported as
luetic infection and associated with Mortality from rupture is high (25 to
pregnancy. 57%), whereas in the case of elective
Aneurysms generally isolated iliac repair is below 5%. At present, most
artery asymptomatic until the time of surgeons recommended elective
breakage, however some typical repair of isolated iliac aneurysms
symptoms are gastrointestinal in one threshold with a diameter of
third of cases as anorexia or mild approximately 3 to 4 cm in patients
abdominal pain. Genitourinary whose risk is favorable.
symptoms ranging from a nonspecific
complaints pyelonephritis ureteral The mortality rate associated with
obstruction or hematuria ureter by surgical treatment of ruptured iliac
erosion. One in five patients has artery aneurysms is around 33%,
symptoms neurogenic compression of similar to aortic aneurysms ruptured.
the obturator nerve, femoral or sciatic. The approach can be performed via
The presence of edema of the retroperitoneal when single, or through
extremities appears in 5% of cases due a transabdominal incision if the lesion is
to venous compression. The presence bilateral. It can perform the interposition
of fever is a symptom of infectious of a graft or an aortoiliac repair
aneurysms. depending on the conditions of the
injury. When there is a possibility of
The deep into the pelvis location placing a minimally invasive
makes their detection by physical endovascular prosthesis in a
examination being almost programmed manner so as
impossible not conclusive in most endovascular treatment aneurysms
cases, making the diagnosis is
imaging. The prognosis is generally good,
although some authors suggest that
Currently the diagnostic method of there is a high tendency for recurrence
choice is computed tomography (CT), of aneurysms either ipsilateral or
which determines the extent and contralateral.
involvement of adjacent structures.
Aneurysms unilateral common iliac CLINICAL CASE
artery, internal and external under three
inches will be monitored annually with Patient 69 years old with a history of
ultrasound. CT and MRI were used in systemic lupus erythematosus disease
those cases in which the ultrasonic of 18 years of evolution,
unavailable. thrombocytopenic purpura secondary to
According to different series, the SLE in the same time evolution, control
majority of aneurysms at the time of echo is detected over 7cm mass
diagnosis have a size between 4 and 5 dependent iliac artery with mural
cm in diameter, while the broken have thrombus and presence Doppler flow
an average diameter of 6 cm. detected with this finding is decided to
The long term monitoring breakage continue joining protocol iliac aneurysm
rates reported between 10 and 70% in exams is: Biometrics 12mg/dl with
after 5 years, however, the relationship hemoglobin, leukocytes and platelets
10,230 17,000. A CT scan and bone

3. scan bone suspected neo-injured and /
or metastasis at L1 and L2.
Angiography: 2cm abdominal aorta
with signs of atherosclerosis, presence
of aneurysm of right common iliac
artery diameter 8cm with mural
thrombus and 1cm light with external
iliac and hypogastric right normal axis
normal left iliac.
Emergency surgery is performed in the
retroperitoneal hematoma which is
about 2000cc, breakage of about 15mm
in outer sidewall for bleeding aneurysm
in the abdominal cavity of about 500cc
ligation is performed iliac artery at the
level of its ostium , internal iliac artery
ligation and external raffia aneurysm
also placed extra-anatomic bypass
femorofemoral with goretex 8mm. After
48 hours in the intensive care unit,
It was decided to schedule surgery for passes general wards with all pulses
aneurysm repair thrombocytopenia present in good general condition. In
after compensating for hematology and subsequent checks the patient is in
bone biopsy result review to assess good condition.
patient survival, but in the process the
patient decompensation characterized
by acute abdominal pain and
hypotension, emergency admission is
done with diagnosis of injured iliac
aneurysm; requested in the TAC
evidence that dye leakage, aneurysm
edge indistinguishable, aneurysmal wall
rupture, darkening of the iliopsoas
muscle and high density mass.
Biometrics 8mg/dl shows hemoglobin.

4. Aneurysms isolated iliac artery disease displacement of the aneurysm,
are a little emergency happens to the operating
as reported frequent work Rozhl and room for surgical correction of ruptured
collaborators, with an incidence of iliac aneurysm.
0.03%. Due to the lack of experience
you have with this disease, its natural The surgical approach in this case will
history is not well known. Indeed, rates be decided by the transabdominal route
of breakage most familiar are the surgical group
not been well established, and the also by the poor condition of the
differences to assess this aspect patient, concomitant factors such as
between common iliac arteries, internal thrombocytopenia (17000), severe
and external to a specific size. anemia, blood loss and as the road that
had more experience the surgical team,
In the series published by Minato raffia underwent aneurysm, ligation of
describes the clinical picture is not internal and external iliac arteries and
specific enough. The reasons for placed extra-anatomic bypass
consultation are related to the femorofemoral to restore the flow of the
commitment of neighboring organs like right leg with goretex 8mm. Although
kidney, ureters, colon and rectum, so there are some reports of bilateral
you need to have a high index of hypogastric occlusion without major
suspicion. In our case it was an complications have been reported
incidental finding on a routine incidences of up to 80% of buttock
abdominal echo was the presence of a claudication, ischemic colitis, erectile
mass of more than 7 cm dependent dysfunction and even serious pelvic
iliac artery with Doppler flow inside. ischemia, especially before an inferior
Angiography is requested following the mesenteric artery occluded also in this
aneurysm diagnostic algorithm in the case was kept the left iliac axis so that
same primitive is evidence 8cm iliac the risk of this type of ischemia does
aneurysm without signs of cracking, not exist.
with mural thrombus and flow within,
the iliac artery and aorta are sized There retroperitoneal approach for
normal. Surgery is planned repair of handling unilateral aneurysms not
aneurysm risk of rupture rates reported injured and programmed routine that
between 10 and 70% at five years, with provides a best exposure and provides
a mortality rate in untreated patients greater choice for correction.
90%. And is expected to compensate
for the end of thrombocytopenia and Currently the management of isolated
investigate suspected neoplasm lumbar iliac aneurysm is best via endovascular
spine. S While awaiting the outcome of therapy, which continues to evolve as
therapy established by hematology and improved refining devices. The
bone biopsy to surgery and repair the endovascular management has a very
aneurysm, in such circumstances high success rate with low morbidity
patient clinical picture characterized by technical as shown by the number of
severe abdominal pain, hypotension, it Sahgal et al and Sanchez work with 35
is offset emergency and requested aneurysms, which showed only a
emergency tomography evidenced technical failure, the monitoring was
signs of iliac wall rupture, aneurysm done 13 and 72 months, during which
indistinguishable edge, obscuring the there were five deaths from causes
left psoas muscle and anterior other than the aneurysm. The

5. endovascular management is a safe Surgery, Firth Edition.
alternative to medium term in patients Philadelphia: Saunders
at high surgical risk, especially useful in Company; 2000. pp 1246-1280.
those with medical contraindications, 2. Feinberg RL, Trout HH. Isolated
surgical and anatomical open handling. Iliac Artery aneurysm in Stanley
Endovascular therapy is an alternative JC, Ernst CB Editors. Current
treatment with comparable results to Therapy in Vascular Surgery,
traditional surgery, indicated in patients Fourth Edition. St Louis
with high surgical risk for diseases Missouri: Mosby; 2001. pp 313-
attendant. In some cases it is 316.
postulated as the first indication. Has 3. Hood DB, Hodgson Kj.
advantages over surgery, such as a Angioplastia transluminal
lower rate of mortality, no general percutánea y colocación de
anesthesia is required, less blood loss endoprótesis para la
and recovery time and shorter hospital enfermedad oclusiva de la
stay. As for the disadvantages, we arteria ilíaca. Clínicas
should consider mycotic Quirúrgicas de Norte América.
pseudoaneurysms by the implicit risk of Cirugía endovascular y vascular
infection of the device, but has already y vascular mínimamente
been successful endovascular penetrante 1999; vol 3. pp 571-
treatment in such cases. 72.
4. Sahgal A, Veith FJ, Lipsitz E.
In cases of ruptured iliac aneurysm Diameter changes in isolated
experience in this type of surgery is iliac artery aneurysms 1 to 6
minimal so you can not generalize its years alter endovascular graft
use. In our institution we started a few repair. J Vasc Surg 2001; 33:
years ago peripheral endovascular 289-94; discussion 294-5.
procedures, but at no time have the 5. Serracino-Inglott F, Myers P. An
technology and experience sufficient to alternative to aorto-uni-iliac
resolve such cases in this way. EVAR and femoro-femoral
crossover in a patient having an
In bilateral aneurysms and patients in aorto-iliac aneurysm with an
good general condition should be occluded external iliac artery.
preferred or bifemoral aortobiilíaco Eur J Vasc Endovasc Surg
bridge, preserving as much as possible, 2007; 33: 575-7.
the circulation of the internal iliac this 6. Cardon JM et al: Endoprosystem
because in these patients there is a I: A multicentric French study. J
high tendency to develop an abdominal Cardiovasc Surg 1996: 37: 45-
aortic aneurysm (AAA). For patients in 50.
poor general health, or with severe 7. Ricci MA, Najarian K, Healey
comorbidities, should be managed with CT. Successful endovascular
stents. treatment of a ruptured internal
iliac aneurysms. J Vasc Surg.
REFERENCES 2002; 35: 1274-6.
8. Dosluoglu HH, Dryjski ML,
1. Cronenwett MD, Krupski WC, Harris LM. Isolated iliac artery
Rutherford RB. Abdominal Aortic aneurysms in patients with or
and Iliac Aneuriysms. In without previous abdominal
Rutherford R, editor. Vascular

6. aortic aneurysm repair. Am J artery bypass in endovascular
Surg. 1999; 178: 129-32. repair of abdominal aortic
9. Hechelhammer L, Lachat ML, aneurysms with bilateral iliac
Wildermuth S, Bettex D, Mayer artery aneurysms. J Vasc Surg
D, Pfammatter T. Midterm 2006; 44: 1170-5.
outcome of endovascular repair 16. Greenberg RK, West K, Pfaff K,
of ruptured abdominal aortic Foster J, Skender D, Haulon S,
aneurysms. J Vasc Surg. 2005; ET AL. Beyond the aortic
41: 752-7. bifurcation: branched
10. Ohki T, Veith Fj. Endovascular endovascular grafts for
grafts and other image-guided thoracoabdominal and aortoiliac
catheterbased adjuncts to aneurysms. J Vasc Surg 2006;
improve the treatment of 43: 879-86.
ruptured aortoiliac aneurysms. 17. Pitoulias GA, Donas KP, Schulte
Ann Surg. 2000; 232: 466-79. S, Horsch S, Papadimitriou DK.
11. Bierdrager E, Lohle PN, Isolated iliac artery aneurysms:
Schoemaker CM, Lampmann endovascular versus open
LE, van BergHenegouwen DP, elective repair. J Vasc Surg
Hamming JF. Successful 2007; 46: 648-54.
emergency stenting of acute 18. Warrwn MJ, Fabian S, Tisi P.
ruptured false iliac aneurysm. Endovascular PTFE-covered
Cardiovasc Intervent Radiol. stent for treatment of an external
2002; 25: 72-3. iliac artery pseudoaneurysm in
12. Williamson AE, Annunziata G, the presence of chronic
Cone LA, Smith J. Endovascular infection. Cardiovasc Intervent
repair of a ruptured abdominal Radiol 2007: 30: 770-3.
aortic and iliac artery aneurysm 19. Gabrielli R, Irace L, Felli MM,
with an acute iliocaval fistula Alunno A, Rizzo AR, ET AL.
secondary to lymphoma. Ann Classic and endovascular
Vasc Surg. 2002; 16: 145-9. surgical management of isolated
13. Lee WA, Hirneise CM, Tayyarah iliac artery aneurysms. Minerva
M, Huber TS, Seeger JM. Cardioangiol 2007; 55: 133-48.
Impact of endovascular repair 20. Tielliu IF, Verhoeven EL,
on early outcomes of ruptured Zeebregts CJ, Prins TR, Oranen
abdominal aortic aneurysms. J BI, Van den Dungen JJ.
Vasc Surg. 2004; 40: 211-5. Endovaascular treatment of iliac
14. Moise MA, Woo EY, Velázquez artery aneurysms with a tubular
OC, Fairman RM, Golden MA, stent-graft: mid-term results. J
Mitchell MEet al. Barriers to Vasc Surg 2006; 43: 440-5.
endovascular aortic aneurysm
repair: past experience and
implications for future device
development. Vasc Endovasc
Surg 2006; 40:197-203.
15. Unno N, Inuzuka K, Yamamoto
N, Sagara D, Suzuki M, Konno
H. Preservation of pelvic
circulation with hypogastric