Porcelain-looking inflammatory aneurysm of the common iliac artery: a literature review

Abstract

The pathogenesis of iliac artery aneurysms is multifactorial and similar to that of abdominal aortic aneurysms (AAA). Contributing etiologies include predominantly atherosclerotic changes, inflammatory processes, arterial wall stress and strain, proteolytic degradation of arterial wall tissue, and molecular genetics. Most patients experience abdominal pain, although some cases may mimic symptoms of other conditions, similar to the pain of appendicitis. The prevalence is higher in males and in the age group between 65 and 75 years. Diagnosis is usually made through imaging and physical examination. Ultrasonography is commonly used as a screening study, while Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) provide images with greater precision or accuracy. The goal of surgical intervention is to eliminate aneurysmal flow and wall tension, thereby preventing further dilation and rupture. Several reconstruction options have been proposed, including resection of the aneurysm with reconstruction of the artery using prosthetic material, aneurysmorrhaphy and reconstruction using a venous or prosthetic graft. Endovascular treatment has been increasingly used, with advantages such as less blood loss, minimal trauma, faster recovery and shorter hospital stay. However, in some cases, open surgical repair may be preferable due to limitations of the endoluminal approach. Some alternative techniques have been developed, such as open surgical repair through a median incision, retroperitoneal approach or endovascular treatment, to preserve blood flow in the hypogastric arteries in patients with incompatible anatomy, demonstrating technical success and low rate of pelvic ischemia.