Between 1982 and 1991, 38 cases of ruptured solitary iliac artery aneurysm (SIAA) were reported in the English literature. Iliac artery aneurysms are frequently found in conjunction with abdominal aortic aneurysm (AAA); however SIAA is a rare entity. Review of the literature and 4 new cases revealed a diversity of clinical presentation that may be partially explained by various mechanisms of SIAA rupture. Different from rupture of the AAA, symptoms of ruptured or leaking SIAA may be obscure and even present as a chronic disease. Emergent operative management is mandatory and requires endoaneurysmorrhaphy with interposition graft for the common and external iliac aneurysms or ligation of internal iliac aneurysms. The reported mortality of up to 75% reflects the delay in diagnosis, lack of operative experience with this particular entity, and frequent associated complications.
Get full access to this article
View all access options for this article.
References
1.
Richardson JW , Greenfield LJ: Natural history and management of iliac aneurysms . J Vasc Surg8:165-171, 1988.
Brunkwall J. , Hanksson H., Bengtson H., et al: Solitary aneurysms of iliac arterial system: An estimate of their frequency of occurrence. J Vasc Surg10:381-384, 1989.
4.
Kasulke RJ, Clifford A., Nichols K., et al: Isolated atherosclerotic aneurysms of the internal iliac arteries . Arch Surg117:73-77, 1982.
Wills JS, Herrera L., Kester R.: Spontaneous arteriovenous fistula between common iliac artery and vein. Cardiovasc Intervent Radiol5:246-248, 1982.
9.
Caralis J.: Isolated aneurysm of the common iliac artery with rupture: Report of a case . J Am Osteopath Assoc83:97-99, 1983.
10.
Perdue GD, Mittenthal MJ, Smith III RB, et al: Aneurysms of the internal iliac artery. Surgery93:243-246, 1983.
11.
Vo NM, Russell JC, Becker DR: Ruptured iliac artery aneurysms: Analysis of 56 cases. Conn Med47:535-538, 1983.
12.
Richards IiiDD: Spontaneous fistula between a right common iliac artery aneurysm and iliac vein. JAMA251:1189-1190, 1984 .
13.
Boyarsky AH, Burks WP, Davidson JT, et al: Ruptured aneurysms of internal iliac artery. SouthJ Med78:1356-1357, 1985.
14.
Campbell WB , van Beek DF, Wood Rfm: Internal iliac artery aneurysm and arteriovenous fistula presenting with pulmonary embolism. Br J Surg72:754-755, 1985
15.
Duppler DW, Herbert WE, Dillihunt RC, et al: Primary arteriovenous fistulas in the abdomen. Arch Surg120:786-790, 1985.
16.
Mashiah A., Merhav H., Pasik S., et al: Femoro-femoral crossover bypass for ruptured iliac artery aneurysm . J Cardiovasc Surg27:49-50, 1986.
17.
Cheung A., Shuman WP, Kohler TR: Diagnosis by computed tomography of arteriovenous fistula complicating ruptured iliac artery aneurysm. J Vasc Surg6:605-608, 1987.
18.
Mestres CA, Ninot S., Guerola M., et al: Spontaneous iliacocaval arteriovenous fistula: The case for differential diagnosis. Br J Surg74:1178-1179, 1987.
19.
Aladgem D., Mazor A., Kashtan H., et al: Colonic bleeding due to rupture of an isolated iliac artery aneurysm into a caecal carcinoma. Postgrad Med64:636-637, 1988.
20.
Bolin T., Lund K., Skan T.: Isolated aneurysms of the iliac artery: What are the chances of rupture?Eur J Vasc Surg2:213-215, 1988.
21.
Drissi-Kacemi A.: Isolated internal iliac artery aneurysm. Report of one case and review of the literature. J Cardiovasc Surg29:68-69, 1988.
22.
Irwin ST, Barros D'sa AA, Irwin Jws, et al: Major arteriovenous fistula complicating aortoiliac aneurysms . J Cardiovasc Surg29:26-31, 1988.
23.
Walstra Brj , Janevski BK, Jorning Pjg: Primary arteriovenous fistula between common iliac vessels: Ultrasound, computer tomographic and angiographic findings. A case report. Angiology40:222-226, 1989.
24.
Katagiri M. , Ksuya SH: Surgery for an isolated aneurysm of the internal iliac aneurysm. J Cardiovasc Surg31:118-120, 1990.
25.
Zelikovski A., Gutman H., Friedman M., et al: Unusual presentations of aortoiliac aneurysms. Isr J Med Sci26:270-274, 1990.
26.
Brewster DC , Cambria RP, Moncure AC, et al: Aortocaval and iliac arteriovenous fistulas. Recognition and treatment. J Vasc Surg13:253-265, 1991.
27.
Gilling-Smith GL, Mansfield AO: Spontaneous abdominal arteriovenous fistulae; report of eight cases and review of the literature. Br J Surg78:421-426, 1991.
28.
Aseem WM, Schachter LG, Devlin JE, et al: Rupture of an internal iliac artery aneurysm into rectum: Fatal consequence of an ilioenteric fistula. Vasc Surg21:151-155, 1992.
29.
Netto NR, Lemos GC, Ikari O., et al: Urological aspects associated with isolated hypogastric artery aneurysm. Urology28:486-488, 1986.
