Duplex Scanning for Detection and Follow-Up of Iliac Artery Aneurysms and Pseudoaneurysm Amenable to Endovascular Therapy

Duplex ultrasound can be a valuable tool in detecting potentially life-threatening iliac artery aneurysms and pseudoaneurysms amenable to endovascular therapy. Four patients were found to have aneurysms other than abdominal aortic aneurysms, which were treated successfully with endovascular exclusion techniques. These included a 5.4 x 5.1-cm pseudoaneurysm arising from the distal anastomotic site of a previous aortic aneurysmorrhaphy; a 7.8 x 6.4-cm right common iliac artery aneurysm with an associated arteriovenous fistula that caused high-output heart failure, and a 4.1 x 5.0-cm aneurysm of the left internal and common iliac artery in a patient who had previous surgical repair of an aortic aneurysm with a bifurcated graft. A patient with a 7.5-cm aneurysm of the internal iliac artery also was treated, but the initial ultrasound diagnosis was made by a referring hospital. Treatment methods included placement of bifurcated endografts (two cases), use of a covered stent (one case), and use of a single iliac component from an aortic endograft (one case). Three internal iliac arteries were embolized with coils. In one patient, subsequent duplex surveillance identified a stenosis within a covered stent. This was treated with placement of a balloon-expandable stent.