Combined abdominal aortic aneurysm and internal iliac arterial aneurysm.

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.