Open Repair Of 14 Cm Internal Iliac Artery Aneurysm
Keith D. Calligaro, MD, Nich Madden, DO, Matthew J. Dougherty, MD, Douglas A. Troutman, DO.
Pennsylvania Hospital, Philadelphia, PA, USA.
DEMOGRAPHICS
64 yo male
HISTORY 64 yo male was admitted for inability to void and change in mental status. On examination, patient had chills and rigors, temperature = 103.1 F, BP = 100/85 mm Hg. Abdomen exam revealed non-tender pulsatile mass in lower midline. WBC = 3.2. Creatinine = 9.3. CT scan showed 6 cm right common iliac (R CIA), 5 cm right internal iliac artery (R IIA), 2 cm left common iliac artery (L CIA), and 14 cm left internal iliac artery (L ICA) aneurysms (images to be shown). Patient was diagnosed with urosepsis and transferred to our facility. IR placed emergent percutaneous nephrostomy tubes and broad-spectrum antibiotics were started. The next day creatinine = 8.2 and WBC = 17.8.
When would you repair internal iliac aneurysms?
How - endo (how) or open (how)?
PLAN An arteriogram was performed to determine if a stent graft could be placed into either or both internal iliac arteries with adequate distal seal, with or without embolization of side branches, so a graft placed via open surgery could be anastomosed to the proximal part of the stent grafts.
Would you insert a Viabahn stent graft into the distal R IIA, L IIA, or both? (images to be shown).We could not place stent grafts because of unsuitable distal internal iliac landing zones.
DISCUSSION Ideally internal iliac artery aneurysms are treated with endovascular intervention due to the technical challenges of performing an anastomosis deep in the pelvis. However, vascular surgeons need to be aware of technical tips to perform this challenging open surgery.(image shows R CIA aneurysm with vessel loop around L CIA; internal iliac aneurysms are not visualized) 
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