Noticias

Noticias

  • Título: New information on size-based indications for treatment of hypogastric artery aneurysms: 4cm should be the new threshold
  • Fecha: 26-10-2015

  • Frank J Criado, MD, FACS, FSVM


    Matti Lane (from Helsinki University Hospital) presented a most interesting recent study at the annual meeting of the European Society for Vascular Surgery (ESVS) held in Porto, Portugal in September 2015. The retrospective multi-center clinical study concluded that hypogastric (internal iliac) artery aneurysms that are less than 4cm in diameter have a low risk of rupture, suggesting that the threshold for elective treatment may be safely increased from the current 3cm to 4cm. This would be of potential benefit to many patients considering the technical difficulties and considerable risks involved in the treatment of such aneurysms – whether surgical or endovascular.

    From 1995 to 2015, 66 patients (mean age 77 years, 15% women) with hypogastric artery aneurysms were enrolled at medical centers in Hungary, Sweden, Australia, New Zealand, Finland, Norway and Germany. Laine noted that hypogastric aneurysms are usually associated with other aneurysms: 48% of patients had bilateral hypogastric aneurysms, 62% had also a common iliac artery aneurysm, and 50% had an AAA. Twenty eight per cent had an isolated hypogastric artery aneurysm. Treatment details of the ruptured aneurysms and patient outcomes were collected from CT scans and medical records. The investigators found that the mean diameter of ruptured hypogastric aneurysms was 6.8cm. The diameter was under 3cm in 1 patient, and under 4cm in 4 others. Isolated hypogastric aneurysms were smaller than those associated with concomitant aneurysms (5.7cm vs. 7.3cm). Most patients (74%) underwent repair by open surgery – largely ligation and over-sewing from within the opened aneurysm sac. Coiling and covered stents or stent-grafts were used in 26% of the cases.

    Overall results of treatment for these ruptured aneurysms were “surprisingly” good with a 30-day mortality of 18% for open surgery and 6% for endovascular repair. They concluded that rupture of hypogastric artery aneurysms of less than 3cm in diameter is “very rare”, and felt that the elective treatment threshold may be “quite safely” increased to 4cm. They also noted that the overall mortality of these ruptures is considerably lower than that expected for a ruptured AAA.



  • Fuente: endovascular.es