Il trattamento convenzionale e con tecnica chirurgica endovascolare degli aneurismi della arteria iliaca= Conventional and endovascular surgical treatment of iliac artery aneurysms

Background. The paper reports a retrospective study designed to assess the feasibility of an endovascular approach as an adjunct to conventional surgical treatment of iliac aneurysms. Methods. In response to the life-threatening tendency to rupture of iliac aneurysms over 3-3.5 cm in diameter, 58 patients were given traditional surgery in 1979-96 and later (1997 - June 1999) in a second group of 16 patients, half (8) were given conventional and 8 endovascular surgical treatment. Results. Of the total number of 66 conventionally treated patients, no significant differences in surgical technique or results and no hospital deaths were identified. Complications included two occlusions of the treated area which were resolved by thrombectomy, two delayed revascularisations and one case of lymphorrhea from the inguinal incision. Of the 8 patients given endovascular surgery, a keyhole approach was employed in 5 cases and the femoral artery had to be exposed in two other cases: one that demanded simultaneous revascularisation of the peripheral circulation and the other involving the use of a particularly wide endovascular device. A nitinol-covered stent was used on all these patients and follow-up varied from 6 to 24 months. In 7 cases the exclusion of the aneurysm was instantaneous. In the one case of endoleak caused by reflux from the hypogastric artery, a CT scan four months later revealed spontaneous thrombisation of the aneurysmatic sac that had eliminated the leakage. In the one patient requiring isolation of the hypogastric artery, gluteal claudication developed but regressed spontaneously over a 3-month period. There were no postoperative complications of any kind. Conclusions. It was therefore concluded that while conventional surgery remains the treatment of choice for iliac aneurysms, the endovascular approach is a valid alternative in the right clinical and morphological conditions.