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  • • Occur with abdominal aortic aneurysms (AAA) in 20%

    • Natural history of these aneurysms unknown

    • Rupture occurs frequently but believed to be rare in aneurysms < 3 cm

    • -Size most important determinant of rupture risk

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Epidemiology

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  • • Isolated iliac aneurysms rare

    • Occurs in < 1% of population over age 50

    • Solitary iliac aneurysms of common iliac artery, 70% of cases; of internal iliac, 20% of cases; of external iliac, 10% of cases

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Symptoms and Signs

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  • • 50% of patients are symptomatic

    • -Compression or erosion into surrounding structures

      -Rupture

    • Sepsis from ureteral obstruction causing pyelonephritis

    • Erosion or rupture into ureter or bladder can cause hematuria, possibly massive

    • Neurologic symptoms

    • -Compression of femoral, obturator, sciatic nerves

    • Massive leg swelling

    • -Rupture of iliac artery into iliac vein causing AV fistula

    • Most symptomatic iliac aneurysms palpable on abdominal or rectal exam

    • Perianal ecchymosis and decreased sphincter tone seen in cases of rupture

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Imaging Findings

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  • • US, CT scan, MRI, arteriography can diagnose

    • US depth of arteries in pelvis, overlying intestinal gas may limit study

    • CT scan and MRI excellent

    • Arteriography may look normal because of mural thrombus; done to evaluate pelvic circulation prior to repair

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  • • Evaluate for other sites of peripheral aneurysms

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  • • CT scan and MRI

    • Arteriography

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  • Solitary aneurysms:

    • -Retroperitoneal approach

      -Hypogastric artery can be safely ligated if contralateral artery is normal

      -If ipsilateral hypogastric aneurysmal, open saci and ligate branches

    • Bilateral common iliac artery aneurysm:

    • -Bifurcated interposition graft

    • Many treated with endovascular repair

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Surgery

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Indications

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  • • Iliac aneurysms > 3 cm with good operative risk, consider repair

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References

Parsons RE et al. Midterm results of endovascular stented grafts for the treatment of isolated iliac artery aneurysms. J Vasc Surg. 1999;30:915.  [PubMed: 10550190]
Sahgal A et al. Diameter changes in isolated iliac artery aneurysms 1 to 6 years after endovascular graft repair. J Vasc Surg. 2001;33:289.  [PubMed: 11174780]

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