Object In a previous study, we have found that an operation for a combinati
on of internal iliac aneurysms and an abdominal aortic aneurysm carries a h
eavier mortality than an operation for an abdominal aortic aneurysm alone.
The object of this review war 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 asymptomat
ic infrarenal aortic aneurysms. The size of the iliac aneurysm was evaluate
d in terms of the calibre of the artery above and below the aneurysm and th
ese size were classified as < 2C, = 2C and > 2C relative to that calibre. T
hree 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 aneurym > 2C.
Results. 32 patients had combined aneurysms (9 group 1, 13 group 2 and 10 g
roup 3) - i.e. 7 %. Treatment consisted of 23 exclusions by ligation, nearl
y all proximal, 6 bypasses of which 2 eventually required a ligation and 2
wrapping. Three patients aged 78, 82 and 86 years died, but no death was re
lated to the treatment of the internal iliac aneurysms. On the other hand,
massive haemorrhages occurred during the operation in a group 2 patient dur
ing an attempt at exclusion by ligation above and below the aneurysm and al
so in a group 3 patient during an unsuccessful attempt at bypassing. One fu
rther bypass proved impossible. Later, 2 group 3 patients developed postope
rative complications: one buttock claudication and one invalidating paraple
gia.
Conclusion. It is justifiable not to operate on < 2C and, in some cases, =
2C, internal iliac aneurysms. Embolisation was not used in this series. Exc
lusion 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 wrappi
ng when the size is < or = 2C and endoneurysmorrhaphy + wrapping when die s
ize is > 2C and performing a bypass may be risky. Unoperated internal iliac
aneurysms should be: periodically controlled with Duplex or CT scan.