Rupture of internal iliac artery aneurysms

Aim-Background An isolated aneurysm of the internal iliac artery is rare, but rupture has a high mortality rate, making it thus a challenging clinical entity in need of special attention as to its immediate diagnosis and treatment. Methods We present a case of ruptured isolated aneurysm of the internal iliac artery, as well as a literature review of relevant publications focusing on ruptured internal iliac artery aneurysms since 1990. Results Out of a total of 43 cases with ruptured internal iliac artery aneurysm, 37 were isolated internal iliac artery aneurysms, while in 6 cases repair of abdominal aortic aneurysm (AAA) had preceded. Abdominal pain was the most common symptom and computed tomography (CT) was the diagnostic tool in all. A rupture into another organ was reported in 10 (23%) cases; into the urinary tract (urinary bladder or ureter) in 5 (11.5%) patients, bowel in 3 (7%), and inferior vena cava in 1 (2.3%) patient. The treatment was open surgery in 18/43 cases (42%), endovascular repair in 22/43 (51%), a combination of the two methods in 2/43 (4.6%), while in one case (2.3%), there was no information regarding treatment. Death occurred in 6/43 patients (14%), 3 of whom (7%) were treated with open surgery and 3 (7%) with endovascular means. Conclusions Immediate diagnosis and treatment lead to good results, as concerns both open and endovascular repair of ruptured aneurysms of the internal iliac artery. A fundamental prerequisite is close cooperation between vascular surgeons and radiologists.