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PENETRATING ILIAC ULCERS
Tanya R. Flohr, MD, Klaus Hagspiel, MD, Margaret C. Tracci, MD, JD, John A. Kern, MD, Irving L. Kron, MD, Kenneth J. Cherry, MD, Patrick T. Norton, MD, Gilbert R. Upchurch, Jr., MD.
University of Virginia, Charlottesville, VA, USA.
OBJECTIVES: This review assesses the characteristics of penetrating iliac ulcers (PIU), as well as, the morbidity and mortality associated with them.
METHODS: From October 2010 to August 2011, 157 patients were identified as having a penetrating ulcer on CT angiogram of the chest, abdomen or pelvis. A total of 32 patients with 36 PIUs were identified. Medical records were reviewed for patient demographics, comorbidities, medications, and tobacco use. CT angiograms were reviewed by two licensed radiologists. Student’s t test was used to compare ages between genders and for PIC occurring in various locations.
RESULTS: PIU represented 20% of the penetrating ulcers identified during the study period, including ascending, arch, descending thoracic, infrarenal, iliac and femoral. Of the 32 patients with PIU identified, 27 (84%) were male and the average age was 71.93±10.43 years. There was no difference in age between genders (p=0.44). Follow-up over a period ranging from 1 month to 4 years with repeat CT angiograms was performed for 15 (47%) patients. All PIU were essentially unchanged with repeat imaging. Survival during the follow-up period was 97%. Twelve (38%) patients with PIU had multiple penetrating ulcers including 9 (28%) patients with infrarenal penetrating aortic ulcers. Twenty three (72%) patients with PIUs were current or former smokers. The most common associated comorbidities in patients with PIU were hypertension (75%), hyperlipidemia (66%) and aneurismal disease (56%). The location of all PIUs are included below. (Figure 1.) No difference in age was noted for right versus left and common versus distal (p=0.27 and 0.91, respectively). More than 60% of PIUs identified were adjacent to the IVC and iliac veins, including those PIUs found along the common iliac arteries (CIA), specifically right posteriolateral, right medial and left lateral CIA.
CONCLUSIONS: PIUs account for a moderate percentage of all penetrating ulcers identified and yet their characteristics and natural history are not well described. These data suggest that while they commonly occur in hypertensive males, PIUs are relatively benign. Further characterization needs to be performed before recommendations for repair can be given. 
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