Median length of stay was 10.5 days in the open group and one day in the endovascular elective group (P <.01). There was no mid-term aneurysm-related mortality in either group. Primary patency rates were similar between the open and endovascular groups at five years (100% vs. 96%, P =.07).
Full Answer
What are the treatment options for iliac artery aneurysms?
Isolated iliac artery aneurysms are rare, and treatment by conventional surgery gives good results. Endovascular repair of such aneurysms has recently become the preferred form of treatment, provided the appropriate anatomy for endovascular repair exists.
What is the prognosis of iliac artery (CIA) aneurysms?
Isolated common iliac artery (CIA) aneurysms are rare. In order to prevent the risk of rupture, treatment of these aneurysms is only considered when the diameter exceeds three centimeters. Rupture of a CIA aneurysm is associated with an immediate mortality rate of around 70% [ 1 ].
How long does iliac artery aneurysm size change after endovascular graft repair?
Diameter changes in isolated iliac artery aneurysms 1 to 6 years after endovascular graft repair. J Vasc Surg. 2001 Feb; 33 (2):289–4. discussion 294-5.
What are the options for endovascular treatment of aortic aneurysms?
There are several options for endovascular treatment, the majority of them involving endoluminal occlusion of distal outflow branches (with coils or vascular plugs) in combination with aorta external iliac or common iliac to external iliac stent grafts.
When should a common iliac artery aneurysm be repaired?
Repair of aneurysms exceeding 3.0 cm to 3.5 cm in diameter is recommended to prevent the risk of rupture. Rupture of common iliac artery aneurysms is associated with a risk of mortality approaching 70% (1–3).
What size iliac aneurysm requires surgery?
The diameter of the common iliac artery is approximately 1 cm on average. Considering the threshold for AAA, approximately 3 cm has conventionally been the threshold for surgical intervention.
How is an iliac aneurysm treated?
Medication: You may receive medicine to reduce your cholesterol or blood pressure. Surgery: UVA uses minimally invasive endovascular techniques (only requiring a small incision in the groin) to repair iliac aneurysms. Your surgeon may use a stent-graft or perform open surgery to repair the aneurysm.
How fast do iliac aneurysms grow?
CIAs had an overall baseline diameter of 2.4±0.6 cm with growth rate of 1.0±1.3 mm/year.
How common is a iliac artery aneurysm?
Isolated iliac artery aneurysm are uncommon, accounting for <2% of abdominal aneurysms.
What is the normal diameter of the left common iliac artery?
The diameter of the right iliac artery was 1.19 cm at and the diameter of the left iliac artery was 1.27 cm. There were significantly larger diameters in the male population compared with the female population on Student's t-test except for the left iliac artery.
How serious is an iliac aneurysm?
These arteries further branch into internal iliac arteries and external iliac arteries. A large iliac aneurysm can burst, which can cause life-threatening, uncontrolled internal bleeding.
What does an iliac aneurysm feel like?
Aneurysm growth or rupture – Symptoms of aneurysm growth are not always present, but when they are, the most common symptom is pain, also numbness, weakness in the legs, back, chest, or abdomen. Aneurysm rupture symptoms include dizziness, fainting, rapid heartbeat, or sudden weakness.
What is an EVAR procedure?
Endovascular aneurysm repair (EVAR) is a minimally invasive procedure that can be used to manage abdominal aortic aneurysms. The aorta is the largest artery that carries blood from your heart to other parts of your body.
What causes iliac artery disease?
The condition is caused by atherosclerosis, a buildup in the arteries of a waxy substance called plaque, which contains cholesterol, fat, and calcium. Plaque can narrow or stiffen the iliac arteries, reducing the flow of oxygen-rich blood to the pelvis and legs.
Where is the right common iliac artery?
You have two iliac arteries: one on the right side of the body (called the right common iliac artery) and one on the left (called the left common iliac artery). Both common iliac arteries branch from the base of the aorta. This part of the aorta is called the abdominal aorta because it's in your belly.
What is an aneurysm in the groin called?
A femoral aneurysm is bulging and weakness in the wall of the femoral artery, located in the thigh. Femoral aneurysms can burst, which may cause life-threatening, uncontrolled bleeding.
Abstract
We report our experience of endovascular repair of isolated iliac artery aneurysms using commercially available stent grafts (SGs). Twenty-five patients (mean age 71 ± 7 years) presented with 33 isolated iliac artery aneurysms (common iliac artery n = 29, external iliac artery n = 4). Five patients were symptomatic.
INTRODUCTION
Isolated aneurysms of the iliac arteries are relatively uncommon and account for 2-7% of all intra-abdominal aneurysms.
MATERIALS AND METHODS
In the last 5 years, 29 patients with 37 IIAAs were observed, for an overall incidence rate of 12% of all abdominal aneurysms. Coexisting abdominal aortic aneurysm, isolated internal iliac artery aneurysms, and para-anastomotic iliac aneurysms were excluded from this review. All these aneurysms were initially assessed for endovascular repair.
RESULTS
Overall, in our series, isolated type 1a and type 1b CIAAs have been treated (type 1a, n = 15; type 1b, n = 10); thus, 15 patients (60%) underwent placement of unilateral tube SG and 10 had bifurcated aorto-iliac SGs placed (Fig. 1 ). Different SG types have been employed: Excluder ® (W.L.
DISCUSSION
Similar to abdominal aortic aneurysms, IIAAs occur more often in elderly men with a history of smoking and hypertension; generally, aneurysmal lesions of the iliac arteries are most commonly associated with aneurysms of the infrarenal aorta; previous reports suggested that IIAA is a rare entity and generally recommended repair for a 3 cm aneurysm diameter threshold.
CONCLUSIONS
Our experience suggests endovascular SG treatment of IIAA is a feasible and low-risk procedure.
Author information
Roberto Caronno MD, Gabriele Piffaretti MD, Matteo Tozzi MD, Chiara Lomazzi MD, Nicola Rivolta MD & Patrizio Castelli MD FACS
What is the first line of treatment for an internal iliac aneurysm?
Proximal and distal embolization is the first-line treatment option for internal IAAs because it is minimally invasive and can prevent revascularization due to cross-filling by pelvic collateral vessels (, 1,, 2 ). In particular, this technique is advised for internal IAAs that are sufficiently distant (>2 cm) from the origin of the internal iliac artery to allow proximal embolization (, Figs 6, , 7, ). Catheterization of a site distal to the aneurysm can be technically difficult and time consuming. In such cases, coil packing of the aneurysm sac followed by proximal embolization can also be performed, although doing so usually requires a large number of coils, especially in large aneurysms (, Fig 8, ). Proximal embolization alone is an undesirable option because it necessarily involves the risk of aneurysm revascularization due to abundant pelvic collateral vessels (, 2,, 3,, 8 ).
What is the natural course of an iliac artery aneurysm?
The natural course of an iliac artery aneurysm (IAA) consists of progressive expansion with eventual rupture. With advances in catheter technology, transcatheter embolization and endovascular stent-graft placement have become possible alternatives to surgery in the treatment of IAAs (, 1 –, 3 ).
How rare are IAAs?
On the other hand, isolated IAAs are relatively rare, with an estimated prevalence of 0.008%–0.03% based on large autopsy series (, 6,, 7 ). Like AAAs, IAAs most commonly occur in elderly men. IAAs occur much more frequently in the common and internal iliac arteries than in the external iliac arteries.
What is iliac artery injury?
Iliac artery injury is a complication that may occur when the delivery system for stent-graft placement is advanced through a small or tortuous iliac artery (, 20 ). According to Tillich et al (, 21 ), a high degree of tortuosity is a risk factor for the development of iliac artery injuries in patients undergoing transfemoral delivery of endovascular devices, whereas there is no statistically significant difference between the mean diameter of dissected iliac arteries and that of nondissected arteries. Therefore, the minimum diameter of iliac arteries that is required for the transport of the stent-graft seems to be difficult to determine. The need for iliac angioplasty prior to stent-graft insertion may best be determined on the basis of several predisposing factors such as the size, calcification, and tortuosity of the iliac arteries and the size of the delivery device.
How to treat an infected aneurysm?
The first surgical treatment option for such aneurysms involves in situ placement of an aortic graft but carries a high risk of graft infection. The second surgical treatment option is resection of the aneurysm followed by arterial ligation and creation of an extraanatomic bypass. However, this option involves two major procedures and also carries a risk of infectious aortic stump rupture. Stent-graft placement is not a first-line option for the treatment of infected aneurysms because of a high risk of stent-graft infection (, Fig 3,, ). However, there have been several reports of favorable outcome after stent-graft repair of infected aneurysms (, 13,, 14 ). Therefore, in poor surgical candidates, stent-graft placement may be used to gain time to improve the patient’s condition prior to open surgery and, in certain patients, may even become the definitive treatment.
Where is an infected aneurysm seen?
In addition, a newly developed infected aneurysm is seen in the lower abdominal aorta (arrow). Treatment of an infected aneurysm with stent-graft placement is controversial because of the risk of stent-graft infection and the fragility of the affected artery.
Can iliac artery thrombosis be treated?
Iliac artery injury should be managed promptly because of the risk of subsequent arterial thrombosis and distal ischemia. Most iliac artery injuries can be treated with stent placement (, Fig 19,, ), although some cases may necessitate surgery (endarterectomy or bypass procedure) (, 22 ).
How big is a CIA aneurysm?
Although the CIA is technically considered aneurysmal when reaching a diameter of 1.5 cm, the average size of ruptured CIA aneurysms is approximately 7 to 8 cm. 1 Most importantly, ruptures in aneurysms smaller than 3.5 cm are exceedingly rare.
Which side is the contralateral limb extension deployed?
On the side opposite the iliac aneurysm, a contralateral limb extension is deployed in the standard fashion. On the side ipsilateral to the CIA aneurysm, a second main body is deployed in the ipsilateral leg of the first main body.
Is an aortic aneurysm more common in patients with AAA?
In the presence of an abdominal aortic aneurysm (AAA), however, aneurysmal iliac arteries are significantly more common, accompanying this disease in up to 40% of patients. In this patient subset, the incidence of multiple iliac aneurysms also increases dramatically, such that the majority of patients with AAA and a CIA aneurysm will have bilateral ...
Is an iliac aneurysm uncommon?
Isolated common iliac artery (CIA) and internal iliac artery (IIA) aneurysms are relatively uncommon, occurring in only 0.03% of the population and constituting < 2% and 0.4% of clinically noted aneurysmal disease, respectively. In the presence of an abdominal aortic aneurysm (AAA), however, aneurysmal iliac arteries are significantly more common, ...
Can CIA be treated with endovascular?
It is our experience that the majority of CIA and IIA disease may be treated with endovascular techniques, thus resulting in shorter hospital stays and decreased morbidity and mortality rates compared to open repair. Preservation of one or both hypogastric arteries during endovascular repair can be accomplished through various techniques. As experience with iliac branch grafting continues to grow, it will likely become a first-line endovascular treatment option.
Can a vascular plug be used for occlusion?
Occasionally, a vascular plug has also been used for occlusion. The IIA orifice is then typically excluded with use of a covered stent graft. Attempts to preserve flow by endovascular exclusion are anatomically challenging because the proximal and distal landing zones are often inadequate.
Can an IIA be treated with a coil?
IIA aneurysms are most often treated by endovascular coil embolization of the di stal branches, the aneurysm itself, or a combination thereof. Occasionally, a vascular plug has also been used for occlusion.