Dix F P, Titi M, Al-Khaffaf H
Department of Vascular Surgery, Burnley General Hospital, Burnley, UK.
Eur J Vasc Endovasc Surg. 2005 Aug;30(2):119-29. doi: 10.1016/j.ejvs.2005.04.035.
The isolated internal iliac artery aneurysm (IIIAA) is rare but rupture has a high mortality rate. This paper reviews the available literature regarding the epidemiology, aetiology, natural history, diagnosis and management with a focus on aneurysms of atherosclerotic origin.
A literature search was performed using internet databases PubMed, Medline and Medscape followed by manual cross referencing of relevant articles. Data were retrieved from the papers, tabulated and analysed to form a review of atherosclerotic IIIAA.
Three hundred and seventy-two papers were found relating to internal iliac artery aneurysms in general and 82 were directly relevant to this paper, reporting 94 cases of atherosclerotic IIIAA. For atherosclerotic aneurysms, the median (range) age was 71.9 (47-89) years and 95% were male. The natural history is unclear but is probably one of increasing size, with corresponding increased risk of rupture. Presentation was with rupture in 40%, leading to rapid death if untreated. The death rate in the group as a whole was 31%. The median (range) size of aneurysms at diagnosis was 7.7 (2-13) cm and death was significantly associated with rupture (Spearman correlation coefficient r=0.327, p=0.007). Symptoms included abdominal pain (31.7%), urological symptoms (28.3%), neurological symptoms (18.3%), groin pain (11.7%), hip or buttock pain (8.3%) and gastrointestinal symptoms (8.3%). Diagnosis may also be coincidental as a result of investigation for other conditions. Of particular use in diagnosis and assessment are ultrasound, computerised tomography and magnetic resonance angiography. Surgical treatment is difficult but can be achieved by ligation, excision or endoanneurysmorrhaphy. More recently, radiological treatments include coil embolisation and endoluminal stenting (often in combination) with the established advantages of endovascular repair have yielded promising short term results, although long term follow-up is required to assess complications and the durability of the devices.
Atherosclerotic IIIAA is a rare condition and if undiagnosed is often fatal. Early diagnosis and treatment may reduce morbidity and mortality particularly with the advent of endovascular techniques.
孤立性髂内动脉瘤（IIIAA）较为罕见，但破裂后死亡率很高。本文回顾了有关其流行病学、病因、自然史、诊断和治疗的现有文献，重点关注动脉粥样硬化性起源的动脉瘤。
利用互联网数据库PubMed、Medline和Medscape进行文献检索，随后对相关文章进行人工交叉引用。从论文中检索数据，制成表格并进行分析，以形成对动脉粥样硬化性IIIAA的综述。
共找到372篇与髂内动脉瘤总体相关的论文，其中82篇与本文直接相关，报告了94例动脉粥样硬化性IIIAA。对于动脉粥样硬化性动脉瘤，中位（范围）年龄为71.9（47 - 89）岁，95%为男性。其自然史尚不清楚，但可能是瘤体不断增大，破裂风险相应增加。40%的患者表现为破裂，若不治疗会迅速死亡。整个组的死亡率为31%。诊断时动脉瘤的中位（范围）大小为7.7（2 - 13）cm，死亡与破裂显著相关（Spearman相关系数r = 0.327，p = 0.007）。症状包括腹痛（31.7%）、泌尿系统症状（28.3%）、神经系统症状（18.3%）、腹股沟疼痛（11.7%）、髋部或臀部疼痛（8.3%）以及胃肠道症状（8.3%）。诊断也可能因对其他疾病的检查而偶然发现。超声、计算机断层扫描和磁共振血管造影在诊断和评估中特别有用。手术治疗困难，但可通过结扎、切除或动脉瘤内缝合法实现。最近，放射治疗包括弹簧圈栓塞和腔内支架置入（通常联合使用），血管内修复的既定优势已产生了有前景的短期结果，尽管需要长期随访来评估并发症和装置的耐久性。
动脉粥样硬化性IIIAA是一种罕见疾病，若未被诊断通常会致命。早期诊断和治疗可能降低发病率和死亡率，特别是随着血管内技术的出现。
