Isolated Iliac Artery Aneurysm

Giant internal iliac artery aneurysm successfully treated with endovascular stent-graft placement

“…Iliac artery aneurysms, mostly of the common iliac, have an estimated incidence of just 2% of all abdominal aneurysmal diseases [ 2 , 4 , 7 , 8 ]. Isolated IIAA is defined as a twofold diameter increase without coexisting aneurysm at another location and can be characterized as an unusual variant of aortoiliac aneurysm disease, representing only 0.3% of all aortoiliac aneurysms and a general population prevalence of 0.03% based on large autopsy series [ 1–4 , 6 ]. Most of the IIAAs are diagnosed in association with other intra-abdominal aneurysms [ 8 ].…”

“…Institutional data reveal that IIAAs are present in 10.2% of patients with aortoiliac aneurysms [ 1 ]. Most common etiologic factor for developing IIAA is a degenerative process of the vascular wall mainly associated with arteriosclerosis, while other conditions, such as infection, trauma, connective tissue and arterial wall disorders, and rarely traumatic childbirth, high forceps deliveries, or Caesarian section, have been implicated in the pathogenesis [ 2 , 3 , 6–8 ].…”

“…Due to rare occurrence and usually deep localization within the pelvis, IIAA elusive physical examination is usually incidentally discovered during abdominal imaging examinations or at the time of rupture [ 2 , 3 , 7 ]. Many authors describe that IIAAs can be clinically manifested as a tender, palpable, pulsatile mass in the hypogastrium or the iliac fossa, ascertained by rectal or vaginal examination [ 2 , 3 , 6 , 7 ]. Less frequently, patients are presented with flank pain, local pressure symptoms, or by complaints caused by erosion of adjacent anatomic structures [ 2 , 3 , 7 ].…”

“…Less frequently, patients are presented with flank pain, local pressure symptoms, or by complaints caused by erosion of adjacent anatomic structures [ 2 , 3 , 7 ]. Complaints include abdominal discomfort (constipation, tenesmus, and rectal bleeding), urinary symptoms (hydronephrosis, pyelonephritis, renal failure, and hematuria), neurological symptoms, groin-, hip-, or buttock pain, deep vein thrombosis, and even pulmonary embolism [ 2 , 3 , 6 ]. Neurologic signs are usually present secondary to compression of the pelvic and lumbosacral nerve roots due to IIAA location within pelvis, like in our case, where left sciatic pain caused by deep ipsilateral sacral bone erosion was the patient’s main symptom.…”

“…They usually remain asymptomatic until rupture [ 2, 3 ]. If they get symptomatic, they can be presented with flank pain or with symptoms caused by pressure or erosion of adjacent anatomic structures [ 2 , 3 , 6 ]. Median size of isolated IIAA at discovery time was reported 77 mm, whereas median size of ruptured IIAA was 70 mm compared with 60 mm in the non-ruptured IIAA group of patients [ 3 ].…”