Selection of therapeutic method for isolated iliac aneurysms_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

FANG Zhengdong ,  HU Hejie , WANG Xiaotian , SUN Xiaojie , GE Xinbao , CHENG Can , WANG Wenrui

Department of Vascular Surgery, Anhui Provincial Hospital, Anhui Medical University, Hefei 230001, P. R. China;

Corresponding author：

HU Hejie, Email: hu.hejie@163.com

Keywords：

isolated iliac artery aneurysm; open surgery; endovascular treatment

DOI：

10.7507/1007-9424.201703128

Video：

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Objective To summarize selection of therapeutic method for isolated iliac aneurysms and analyze its advantages and disadvantages. Method The clinical data of 21 patients with isolated iliac aneurysms from January 2006 to January 2017 in this hospital were analyzed retrospectively. Results Four patients were treated with an open surgery such as the unilateral iliac prosthetic graft interposition, aorto-biiliac or aorto-bifemoral arterial bypass graft, ligation of internal iliac artery, etc.. Seventeen patients were treated with an endovascular treatment such as the unilateral iliac stent-grafts, bifurcated aortic stent-grafts, or coil embolization alone, etc.. One patient with ruptured isolated iliac aneurysms died during the endovascular repair, and the rest patients were cured after the operation. The average operative time was 2.83 h and 1.58 h, the average hospital stay was 17.5 d and 7.7 d respectively for the patients with the open surgery and the endovascular treatment. Except 1 case of type Ⅰ and 1 case of type Ⅱ endoleaks were found in the patients with the endovascular treatment, no complications such as the ureteral and intestinal injuries, the gluteal muscle claudication, and the sigmoid ischemia were found in all the patients. Seventeen cases were followed-up. The following-up rate was 85%. The following-up time was 1–60 months with an average of 22 months. During the following-up period, the grafts and stent grafts were patent and the aneurysm sac diameter was unchanged. The abscess of the iliac fossa occurred in 1 patient with systemic lupus erythematosus and improved after the symptomatic treatment. Two patients died of other diseases during the following-up period, and the rest had no obvious clinical symptoms. Conclusions Preliminary results of limited cases in this study show that endovascular repair and open surgery in treatment of appropriately selected patients with isolated iliac artery aneurysms is safe and effective. But in special situation, technical controllability of open surgery might be better than endovascular repair, treatment should be selected according to patient’s general condition and anatomy of aneurysm.

Citation： FANG Zhengdong, HU Hejie, WANG Xiaotian, SUN Xiaojie, GE Xinbao, CHENG Can, WANG Wenrui. Selection of therapeutic method for isolated iliac aneurysms. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(9): 1081-1084. doi: 10.7507/1007-9424.201703128 Copy

1.	Fossaceca R, Guzzardi G, Cerini P, et al. Isolated iliac artery aneurysms: a single-centre experience. Radiol Med, 2015, 120(5): 440-448.
2.	Roddy SP. Outcomes of open and endovascular repair for ruptured and nonruptured internal iliac artery aneurysms. J Vasc Surg, 2014, 59(3): 869-870.
3.	Richardson JW, Greenfield LJ. Natural history and management of iliac aneurysms. J Vasc Surg, 1988, 8(2): 165-171.
4.	郭平凡, 陈福真, 洪志鹏, 等. 孤立性髂动脉瘤 28 例的诊断与治疗. 中华普通外科杂志, 2001, 16(9): 567.
5.	栾景源. 腰椎间盘术后髂动脉假性动脉瘤. 中国微创外科杂志, 2013, 13(4): 361-362, 367.
6.	Kretz B, Pagès PB, Loffroy R, et al. Mycotic aneurysm of both internal iliac arteries due to Candida albicans. Ann Vasc Surg, 2014, 28(3): 738.e11-e14.
7.	Dueppers P, Jankowiak S, Schelzig H, et al. Spontaneous rupture of an isolated iliac artery dissection in a young man because of cystic medial degeneration Erdheim-Gsell. Ann Vasc Surg, 2015, 29(3): 596.e11-e13.
8.	冯勇, 胡海地, 陈喆, 等. 孤立性髂动脉瘤 19 例诊治经验. 中华普通外科杂志, 2009, 24(1): 5-7.
9.	姚陈, 叶彦琛, 李勇辉, 等. 孤立性髂动脉瘤的外科手术治疗. 中国血管外科杂志(电子版), 2015, 7(1): 33-36.
10.	Shareghi S, Gopal A, Gul K, et al. Diagnostic accuracy of 64 multidetector computed tomographic angiography in peripheral vascular disease. Catheter Cardiovasc Interv, 2010, 75(1): 23-31.
11.	Santilli SM, Wernsing SE, Lee ES. Expansion rates and outcomes for iliac artery aneurysms. J Vasc Surg, 2000, 31(1 Pt 1): 114-121.
12.	Minato N, Itoh T, Natsuaki M, et al. Isolated iliac artery aneurysm and its management. Cardiovasc Surg, 1994, 2(4): 489-494.
13.	Matsumoto K, Matsubara K, Watada S, et al. Surgical and endovascular procedures for treating isolated iliac artery aneurysms: ten-year experience. World J Surg, 2004, 28(8): 797-800.
14.	Patel NV, Long GW, Cheema ZF, et al. Open vs. endovascular repair of isolated iliac artery aneurysms: A 12-year experience. J Vasc Surg, 2009, 49(5): 1147-1153.
15.	Buck DB, Bensley RP, Darling J, et al. The effect of endovascular treatment on isolated iliac artery aneurysm treatment and mortality. J Vasc Surg, 2015, 62(2): 331-335.
16.	Igari K, Kudo T, Toyofuku T, et al. Comparison between endovascular repair and open surgery for isolated iliac artery aneurysms. Surg Today, 2015, 45(3): 290-296.
17.	Uberoi R, Tsetis D, Shrivastava V, et al. Standard of practice for the interventional management of isolated iliac artery aneurysms. Cardiovasc Intervent Radial, 2011, 34(1): 3-13.
18.	Melas N, Saratzis A, Dixon H, et al. Isolated common iliac artery aneurysms: a revised classification to assist endovascular repair. J Endovasc Ther, 2011, 18(5): 697-671.
19.	Rayt HS, Brown MJ, Lambert KV, et al. Buttock Claudication an erectile dysfunction after internal iliac artery embolization in patients prior to endovascular aortic aneurysm repair. Cardiovasc Intervent Radiol, 2008, 31 (4): 728-734．.
20.	Shutze RA, Oglesby W, Lee A, et al. Results of repair of iliac artery aneurysms with the sandwich technique. Proc (Bayl Univ Med Cent). 2017, 30(1): 7-10.
21.	栾景源, 李选, 冯琦琛, 等. 开窗覆膜支架腔内修复髂动脉瘤.北京大学学报(医学版), 2012, 44(3): 489-491.
22.	卿洪琨, 张学民, 蒋京军, 等. 自制髂动脉分支装置治疗腹主动脉瘤腔内修复术后髂动脉瘤1例. 北京大学学报(医学版), 2015, 47(5): 888-890.
23.	Noel-Lamy M, Jaskolka J, Lindsay TF, et al. Internal iliac aneurysm repair outcomes using a modification of the iliac branch graft. Eur J Vasc Endovasc Surg, 2015, 50(4): 474-479.
24.	吴科敏, 王伟, 黄建华, 等. 腹主动脉瘤术中不同髂内动脉处理的疗效观察. 中国普通外科杂志, 2014, 23(12): 1620-1624.
25.	李海辉, 赵亮, 谢锐, 等. 破裂性髂动脉瘤的救治体会. 心理医生, 2015, 21(22): 125-127.
26.	Igari K, Kudo T, Toyofuku T, et al. Successful endovascular repair of ruptured isolated bilateral internal iliac artery aneurysms. Eur J Vasc Endovasc Surg, 2013, 45(3): 218-219.

1. Fossaceca R, Guzzardi G, Cerini P, et al. Isolated iliac artery aneurysms: a single-centre experience. Radiol Med, 2015, 120(5): 440-448.
2. Roddy SP. Outcomes of open and endovascular repair for ruptured and nonruptured internal iliac artery aneurysms. J Vasc Surg, 2014, 59(3): 869-870.
3. Richardson JW, Greenfield LJ. Natural history and management of iliac aneurysms. J Vasc Surg, 1988, 8(2): 165-171.
4. 郭平凡, 陈福真, 洪志鹏, 等. 孤立性髂动脉瘤 28 例的诊断与治疗. 中华普通外科杂志, 2001, 16(9): 567.
5. 栾景源. 腰椎间盘术后髂动脉假性动脉瘤. 中国微创外科杂志, 2013, 13(4): 361-362, 367.
6. Kretz B, Pagès PB, Loffroy R, et al. Mycotic aneurysm of both internal iliac arteries due to Candida albicans. Ann Vasc Surg, 2014, 28(3): 738.e11-e14.
7. Dueppers P, Jankowiak S, Schelzig H, et al. Spontaneous rupture of an isolated iliac artery dissection in a young man because of cystic medial degeneration Erdheim-Gsell. Ann Vasc Surg, 2015, 29(3): 596.e11-e13.
8. 冯勇, 胡海地, 陈喆, 等. 孤立性髂动脉瘤 19 例诊治经验. 中华普通外科杂志, 2009, 24(1): 5-7.
9. 姚陈, 叶彦琛, 李勇辉, 等. 孤立性髂动脉瘤的外科手术治疗. 中国血管外科杂志(电子版), 2015, 7(1): 33-36.
10. Shareghi S, Gopal A, Gul K, et al. Diagnostic accuracy of 64 multidetector computed tomographic angiography in peripheral vascular disease. Catheter Cardiovasc Interv, 2010, 75(1): 23-31.
11. Santilli SM, Wernsing SE, Lee ES. Expansion rates and outcomes for iliac artery aneurysms. J Vasc Surg, 2000, 31(1 Pt 1): 114-121.
12. Minato N, Itoh T, Natsuaki M, et al. Isolated iliac artery aneurysm and its management. Cardiovasc Surg, 1994, 2(4): 489-494.
13. Matsumoto K, Matsubara K, Watada S, et al. Surgical and endovascular procedures for treating isolated iliac artery aneurysms: ten-year experience. World J Surg, 2004, 28(8): 797-800.
14. Patel NV, Long GW, Cheema ZF, et al. Open vs. endovascular repair of isolated iliac artery aneurysms: A 12-year experience. J Vasc Surg, 2009, 49(5): 1147-1153.
15. Buck DB, Bensley RP, Darling J, et al. The effect of endovascular treatment on isolated iliac artery aneurysm treatment and mortality. J Vasc Surg, 2015, 62(2): 331-335.
16. Igari K, Kudo T, Toyofuku T, et al. Comparison between endovascular repair and open surgery for isolated iliac artery aneurysms. Surg Today, 2015, 45(3): 290-296.
17. Uberoi R, Tsetis D, Shrivastava V, et al. Standard of practice for the interventional management of isolated iliac artery aneurysms. Cardiovasc Intervent Radial, 2011, 34(1): 3-13.
18. Melas N, Saratzis A, Dixon H, et al. Isolated common iliac artery aneurysms: a revised classification to assist endovascular repair. J Endovasc Ther, 2011, 18(5): 697-671.
19. Rayt HS, Brown MJ, Lambert KV, et al. Buttock Claudication an erectile dysfunction after internal iliac artery embolization in patients prior to endovascular aortic aneurysm repair. Cardiovasc Intervent Radiol, 2008, 31 (4): 728-734．.
20. Shutze RA, Oglesby W, Lee A, et al. Results of repair of iliac artery aneurysms with the sandwich technique. Proc (Bayl Univ Med Cent). 2017, 30(1): 7-10.
21. 栾景源, 李选, 冯琦琛, 等. 开窗覆膜支架腔内修复髂动脉瘤.北京大学学报(医学版), 2012, 44(3): 489-491.
22. 卿洪琨, 张学民, 蒋京军, 等. 自制髂动脉分支装置治疗腹主动脉瘤腔内修复术后髂动脉瘤1例. 北京大学学报(医学版), 2015, 47(5): 888-890.
23. Noel-Lamy M, Jaskolka J, Lindsay TF, et al. Internal iliac aneurysm repair outcomes using a modification of the iliac branch graft. Eur J Vasc Endovasc Surg, 2015, 50(4): 474-479.
24. 吴科敏, 王伟, 黄建华, 等. 腹主动脉瘤术中不同髂内动脉处理的疗效观察. 中国普通外科杂志, 2014, 23(12): 1620-1624.
25. 李海辉, 赵亮, 谢锐, 等. 破裂性髂动脉瘤的救治体会. 心理医生, 2015, 21(22): 125-127.
26. Igari K, Kudo T, Toyofuku T, et al. Successful endovascular repair of ruptured isolated bilateral internal iliac artery aneurysms. Eur J Vasc Endovasc Surg, 2013, 45(3): 218-219.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Selection of therapeutic method for isolated iliac aneurysms

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