Exclusion of internal iliac artery aneurysm in high-risk patients

Abstract

The purpose of this retrospective study was to assess the long-term results after exclusion of an internal iliac artery aneurysm (IIAA) to patients with high-risk conditions. From 1993 to 2000, sixteen patients (15 men and one woman, mean age 75.1 years) with 22 internal iliac artery aneurysms underwent exclusion surgery. Only two patients had solitary IIAA and the remaining fourteen had IIAA associated with abdominal aortic aneurysm (AAA) or common iliac artery aneurysm (CIAA). Of the 16 patients, there were 7 with ruptured aneurysm (43.8%) and the other 9 patients, who had underwent an elective operation, were at high risk for surgery because of existence of advanced cancer in 3, cerebrovascular disease in 2, severe chronic obstructive lung disease in 2, and liver cirrhosis or rheumatoid arthritis with long-term steroid administration in 1 each. The sacs of all IIAA (6 bilateral and 10 unilateral) were excluded without internal iliac artery reconstruction. The operative mortality was 6.3%. Non-fatal ischemic colitis occurred in one patient. Buttock claudication was not recognized. Only one excluded aneurysm expanded and underwent complete resection of the sac 45 months after the initial exclusion surgery. Delayed rupture was not observed in the follow-up periods (mean, 37.9 months). The 3-year and 5-year survival rate was 66.7% and 41.7%, respectively. The exclusion method minimizes surgical intervention and yields an acceptable outcome. This method could be the procedure of choice for high-risk patients.