Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 3  |  Issue : 3  |  Page : 107-108

Isolated Bilateral Common Iliac Artery Aneurysm


Department of General Surgery, Christian Medical College and Hospital, Ludhiana, Punjab, India

Date of Web Publication25-Jul-2016

Correspondence Address:
Dr. Moloti Kichu
Department of General Surgery, Christian Medical College and Hospital, Ludhiana, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-0820.186722

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  Abstract 

The incidence of isolated iliac artery aneurysm is rare. We report a 78-year-old male with isolated bilateral common iliac artery and internal iliac aneurysm. Computerized tomography angiogram of the aorta revealed partially thrombosed aneurysms involving bilateral common iliac and internal arteries with mass effect. The infrarenal abdominal aorta is tortuous and ectatic. The clinical presentation and management are discussed.

Keywords: Aneurysm, iliac artery, tortuous aorta


How to cite this article:
Mahajan A, Luther A, Kichu M, Kumar V. Isolated Bilateral Common Iliac Artery Aneurysm. Indian J Vasc Endovasc Surg 2016;3:107-8

How to cite this URL:
Mahajan A, Luther A, Kichu M, Kumar V. Isolated Bilateral Common Iliac Artery Aneurysm. Indian J Vasc Endovasc Surg [serial online] 2016 [cited 2020 Aug 5];3:107-8. Available from: http://www.indjvascsurg.org/text.asp?2016/3/3/107/186722


  Introduction Top


An isolated iliac artery aneurysm is defined as a two-fold increase in the size of iliac artery without a coexisting aneurysm at another location. It typically occurs in older men and is most commonly degenerative or nonspecific in etiology.[1] Iliac artery aneurysms are the most frequent aneurysm after abdominal aortic aneurysms, and the common iliac artery is the most common site of such aneurysms.[2]


  Case Report Top


A 78-year-old male presented to the emergency department with complaints of pain in the right inguinal region since 1 month. He also complained of pain and swelling of the right lower limb since 7 days. He was a known case of ischemic heart disease, hypertension, and dyslipidemia. The only positive findings were mild tenderness of right inguinal region and decreased right lower limb dorsalis pedis and posterior tibial artery pulsations. Blood investigations done were normal except for hemoglobin which was 7.8 g%. Ultrasound abdomen was done as workup for right inguinal pain which showed a large cystic lesion involving right common iliac and internal iliac arteries 6.2 cm (antero-posterior), 7.3 (transverse), and 11.7 (craniocaudal) indicative of a pseudoaneurysm with intraluminal thrombus. Computerized tomography (CT) angiogram of the abdominal aorta [Figure 1] revealed a partially thrombosed aneurysms involving bilateral common and internal iliac arteries, the right side measuring 10.8 × 8 × 7 cm and left side measuring 6.9 × 6 × 4.8 cm with mass effect in the form of splaying of the mesenteric vessels laterally. The infrarenal aorta was tortuous and ectatic. Preoperative ankle brachial pressure index (ABPI) was 0.7. The patient underwent aorto-bi-femoral bypass grafting with a dacron graft (14 × 7 mm) [Figure 2]. Intraoperative findings revealed aneurysms of both common and internal iliac arteries filled with atheromatous plaque [Figure 3]. The right was larger. The walls of the abdominal aorta were calcified. Postoperatively, the patient recovered well and had ABPI of 0.9. Patient was discharged in satisfactory condition and is on follow-up.
Figure 1: Computerized tomography angiogram abdomen (coronal view) with arrows pointing tortuous abdominal aorta and isolated bilateral common iliac and internal iliac aneurysm

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Figure 2: Postanastomosis (aorto-bi-femoral bypass grafting)

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Figure 3: Intraoperative view showing isolated bilateral common iliac and internal iliac artery aneurysm

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  Discussion Top


Isolated common iliac artery aneurysms are rare. The incidence of isolated iliac artery aneurysm is 2% (70% are present in the common iliac, 20% in the internal iliac, and 10% in the external iliac). Bilateral common iliac artery involvement is seen in 30%. Repair of common iliac artery aneurysm is done for aneurysms more than 3.5 cm in size.[3] A common iliac artery diameter of more than or equal to 1.7 cm in males or 1.5 cm in females is considered ectatic. A diameter of more than or equal to 2.5 is considered aneurysmal.[4] The diagnosis of isolated iliac artery aneurysm may be confirmed by ultrasound, CT scans, magnetic resonance imaging, and arteriography. Although ultrasound is much less expensive than other modalities, a study comparing ultrasound, CT, and intravenous digital subtraction arteriography for the study of abdominal aneurysms found out that ultrasound did not detect iliac aneurysms in 19 of 25 cases, CT and magnetic resonance imaging were equally accurate for diagnosing iliac aneurysm. Angiography is essential for planning elective repair of iliac aneurysm.[5] Endovascular aneurysm repair is the first line of treatment for most anatomically suitable patients who require common iliac artery aneurysm repair.[6] Patients with compressive symptoms or those with arteriovenous fistula should preferentially be treated with open surgery.[6] Our patient underwent aorto-bi-femoral bypass grafting, and postoperatively, the patient did not show any signs of complication and patient was discharged with advice to follow-up.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
William CK, Craig HS, Rosario F, Pamela RN, Mark RN, Thomas AW. Contemporary management of isolated iliac aneurysms. J Vasc Surg 1998;28:1-13.  Back to cited text no. 1
    
2.
McCready RA, Pairolero PC, Gilmore JC, Kazmier FJ, Cherry KJ Jr., Hollier LH. Isolated iliac artery aneurysms. Surgery 1983;93:688-93.  Back to cited text no. 2
    
3.
Sakamoto I, Sueyoshi E, Hazama S, Makino K, Nishida A, Yamaguchi T, et al. Endovascular treatment of iliac artery aneurysms. Radiographics 2005;25 Suppl 1:S213-27.  Back to cited text no. 3
    
4.
Khosa F, Krinsky G, Macari M, Yucel EK, Berland LL. Managing incidental findings on abdominal and pelvic CT and MRI, Part 2: White paper of the ACR Incidental Findings Committee II on vascular findings. J Am Coll Radiol 2013;10:789-94.  Back to cited text no. 4
    
5.
Vowden P, Wilkinson D, Ausobsky JR, Kester RC. A comparison of three imaging techniques in the assessment of an abdominal aortic aneurysm. J Cardiovasc Surg (Torino) 1989;30:891-6.  Back to cited text no. 5
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6.
Huang Y, Gloviczki P, Duncan AA, Kalra M, Hoskin TL, Oderich GS, et al. Common iliac artery aneurysm: Expansion rate and results of open surgical and endovascular repair. J Vasc Surg 2008;47:1203-10.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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