AORTOILIAC ANEURYSMS RUPTURING INTO THE I LIAC VEINS

Background: Rupture of aorto-iliac aneurysms into the iliac veins is s eldom reported in distinct series, and represents only a fraction of r uptures into the abdominal cavity. Material and methods: Four cases ar e reported: two aortic aneurysms ruptured into the right iliac vein, o ne right iliac aneurysm ruptured into the cava at the bifurcation, one aortoiliac aneurysm ruptured into the right iliac vein. Two patients showed severe shock at admission. Central venous pressure at operation was 43.6+/-26.3 cmH(2)O, and rapidly decreased at aortic clamping. Ve nous bleeding was controlled by finger compression of the iliac and ca val vein and aortic graft replacement followed direct suture repair of the venous breach. De Weese caval clip was implanted twice, to preven t pulmonary embolism in severely compromised iliac veins. This series represents 1% among 373 ruptured abdominal aortic aneurysms operated o n as emergencies over the same period. Results: Pulmonary embolism, ei ther paradoxical or post-operative, never occurred. Mortality rate was 25%, compared to 35% overall mortality among the whole ruptured group . The role of the site of rupture is swelling of the lower limbs is su ggested, and edema can be suggestive though statistical evidence has n ot been achieved. Conclusions: Three concepts are stressed: early diag nosis and operation (i.e. before cardiac high output failure and shock ); accurate as well as simple surgical technique; careful post-operati ve intensive care.