Gabrielli R, Irace L, Felli M M G, Alunno A, Rizzo A R, Faccenna F, Laurito A, Gattuso R, Venosi S, Jabbour J, Gossetti B
Department of Vascular Surgery, La Sapienza University, Rome, Italy.
Minerva Cardioangiol. 2007 Apr;55(2):133-48.
Isolated iliac artery aneurysm is a rare pathology that is often asymptomatic for long periods; this late diagnosis exposes patients to a high risk of death following aneurysm rupture. The aim of this study was to establish the most suitable diagnostic approach, the correct indications for treatment, and the most appropriate tactics and surgical technique.
Twenty-eight patients were observed over 13 years. Aneurysmal involvement was unilateral in 22 cases and bilateral in the remaining 6 patients. Preoperative diagnostic tests included eco-colour Doppler (ECD) and angio-CT in all cases, with angio-MR and angiography as more selective procedures. Seventeen patients underwent conventional open surgery with prosthetic replacement of the aneurysmatic tract, 7 patients were treated using endovascular exclusion, and lastly 4 were monitored over time.
There was no perioperative mortality for either treatment. During the postoperative period following conventional open surgery, complications included one case of severe respiratory failure, one microembolism of the lower limb, and 2 periprosthetic hematoma. During the follow-up, we observed one pseudo-aneurysm, 3 cases of retrograde ejaculation and one patient with erectile dysfunction after traditional surgery; there was one minor endoleak after endovascular exclusion.
Our experience suggests that ECD is a useful method for arriving at an early diagnosis, while angio-CT imaging is essential for a correct preoperative study. Aneurysms with a diameter equal or greater than 3 cm or that present annual increases in excess of 5 mm represent a correct indication for treatment. Conventional open surgery is the treatment of choice for young patients in good general conditions. Endovascular exclusion is indicated when the patient's clinical conditions contraindicate open surgery and the morphology of the aneurysmal arterial district allows the endoprosthesis to be safely implanted.
孤立性髂动脉瘤是一种罕见的病理情况，通常长期无症状；这种晚期诊断使患者面临动脉瘤破裂后死亡的高风险。本研究的目的是确定最合适的诊断方法、正确的治疗指征以及最恰当的策略和手术技术。
在13年期间观察了28例患者。22例患者的动脉瘤累及为单侧，其余6例为双侧。所有病例的术前诊断检查包括彩色多普勒超声（ECD）和血管CT，血管磁共振成像（MR）和血管造影作为更具选择性的检查。17例患者接受了传统开放手术，用人工血管置换动脉瘤段，7例患者采用血管内隔绝术治疗，最后4例患者进行了长期监测。
两种治疗方法均无围手术期死亡。在传统开放手术后的术后期间，并发症包括1例严重呼吸衰竭、1例下肢微栓塞和2例人工血管周围血肿。在随访期间，我们观察到1例假性动脉瘤、3例逆行射精和1例传统手术后勃起功能障碍的患者；血管内隔绝术后有1例轻微内漏。
我们的经验表明，ECD是早期诊断的有用方法，而血管CT成像对于正确的术前评估至关重要。直径等于或大于3 cm或每年增大超过5 mm的动脉瘤是正确的治疗指征。传统开放手术是一般状况良好的年轻患者的首选治疗方法。当患者的临床状况禁忌开放手术且动脉瘤动脉区域的形态允许安全植入血管内假体时，应采用血管内隔绝术。
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