[Aneurysm of iliac arteries. Is it anatomo-clinical entity? Report of 18 cases].

338 patients with aorto iliac aneurysms were operated in the Department of vascular surgery (Hosp. E.-Herriot-University A.-Carrel Lyon). Retrospective evaluation found 20 solitary iliac artery aneurysms (AAIS) in 18 patients (2 bilateral AAIS). 77% of aneurysms were on the common iliac artery, 17% on the internal iliac artery, and one case of mycotic aneurysm on the external iliac artery. 8 patients (44.4%) were asymptomatic, 5 (27.8%) had non specific complaints. Rupture or acute ischemia occurred in 5 cases (27.8%). The incidence of non atherosclerotic cause (dysplasia 33.3%, infection 16.7%) in this series shows a real difference with AAA (atherosclerotic dominant etiologic factor). The value of C.T. scanning and sonographic evaluation and their extensive use in vascular and non vascular diagnostic problems are an obvious explanation for increasing AAIS reports. The risk of rupture is probably higher than in AAA because of the incidence of arterial dysplasias (1/3 in this study) and mycotic origin. This occurrence suggests an aggressive surgical management. Aneurysmorrhaphy with graft interposition by intraperitoneal approach is the routine technique for most of surgeons. An alternative procedure (retroperitoneal approach) was performed on ten of our patients (55.5%). No perioperative mortality and low morbidity rate (one case of phlebitis) in our cases support this surgical management. The survival rate based on actuarial method is estimated 64% at five years (all grafts patent).