Outcome of emergency endovascular treatment of large internal iliac artery aneurysms with guidewires.
OBJECTIVE
Guidewires have been reported as a useful occlusion material for large aneurysms of different locations with good short-term results. In this study we retrospectively evaluate long-term results of emergency embolization technique with guidewires in symptomatic internal iliac artery aneurysm (IIAA) impending rupture.


METHODS
In four patients presented with acute abdominal pain, multidetector computed tomography revealed unstable, 7-14cm large, IIAAs. Two patients were treated with coil embolization of distal branches followed by occlusion of aneurysmal sac with guidewires. In two patients embolization of aneurysmal sac alone was performed.


RESULTS
In three patients complete or near complete occlusion of the aneurysmal sac was achieved and abdominal pain ceased within hours. Two patients treated with embolization of distal iliac artery branches and aneurysmal sac developed claudication that lasted up to 1 year. Their aneurysms remained thrombosed and they were without symptoms until they died 31 and 56 months later of causes unrelated to IIAA. Two patients treated with embolization of the aneurysm alone were free of ischemic symptoms. Because of incomplete embolization of the sac in one patient open surgery treatment in a non-emergency setting was performed. Complete filling of aneurysmal sac was achieved in other patient but 2 years later his aneurysm re-opened and required open surgery treatment.


CONCLUSIONS
Embolization of aneurysmal sac of large IIAA with guidewires may be effective for immediate treatment of impending rupture. Long-term results were better when embolization of the aneurysmal sac was combined with embolization of distal IIA branches.
Cambj-Sapunar
Liana
L
Department of Radiology, University Hospital of Split, Spincićeva 1, 21000 Split, Croatia. lianacambj@hotmail.com
Masković
Josip
J
Brkljacić
Boris
B
Radonić
Vedran
V
Dragicević
Dragan
D
Ajduk
Marko
M
D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic; D004635:Emergency Medicine; D006801:Humans; D017543:Iliac Aneurysm / Q000628:therapy*; D007083:Iliac Artery / Q000473:pathology*; D012189:Retrospective Studies