[Hypogastric arterial aneurysms associated with abdominal aortic aneurysms].

OBJECT: In a previous study, we have found that an operation for a combination of internal iliac aneurysms and an abdominal aortic aneurysm carries a heavier mortality than an operation for an abdominal aortic aneurysm alone. The object of this review was to define the prevalence of this combination of aneurysms and the results of the different treatment modalities in order to define the therapeutic choices.

METHOD: A retrospective study of operations on 426 patients with asymptomatic infrarenal aortic aneurysms. The size of the iliac aneurysm was evaluated in terms of the calibre of the artery above and below the aneurysm and these size were classified as < 2C, = 2C and > 2C relative to that calibre. Three groups were defined: group 1--with at least 1 aneurysm < 2C: group 2--with at least 1 aneurysm = 2C, group 3--with at least 1 aneurysm > 2C.

RESULTS

32 patients had combined aneurysms (9 group 1, 13 group 2 and 10 group 3)--i.e. 7%. Treatment consisted of 23 exclusions by ligation, nearly all proximal, 6 bypasses of which 2 eventually required a ligation and 2 wrappings. Three patients aged 78, 82 and 86 years died, but no death was related to the treatment of the internal iliac aneurysms. On the other hand, massive haemorrhages occurred during the operation in a group 2 patient during an attempt at exclusion by ligation above and below the aneurysm and also in a group 3 patient during an unsuccessful attempt at bypassing. One further bypass proved impossible. Later, 2 group 3 patients developed postoperative complications: one buttock claudication and one invalidating paraplegia.

CONCLUSION

It is justifiable not to operate on < 2C and, in some cases, = 2C, internal iliac aneurysms. Embolisation was not used in this series. Exclusion by ligation is a good procedure when the other internal iliac artery is patent. Bypassing is the ideal method in bilateral aneurysms but it is associated with the risk of venous haemorrhage and of thrombosis. When flow must be maintained in an internal iliac artery, our first choice is wrapping when the size is < or = 2C and endoneurysmorrhaphy + wrapping when the size is > 2C and performing a bypass may be risky. Unoperated internal iliac aneurysms should be periodically controlled with Duplex or CT scan.