Endovascular Therapeutic Options for Isolated Iliac Aneurysms with a Working Classification

Abstract

The purpose of this paper is to demonstrate a variety of stent-grafting and embolization techniques and describe a new classification for endovascular treatment of isolated iliac artery aneurysms. A total of 19 patients were treated for isolated iliac aneurysms. Depending on the proximal iliac neck and the uni-/bilaterality of common iliac artery aneurysms (CIAA's) the patient may be treated by a tube (Type Ia) or a bifurcated stent-graft (Type Ib) in addition to internal iliac artery embolization. Neck anatomy is also critical in determining therapeutical options for internal iliac artery aneurysms (IIAA's). These are tube stent-grafting plus internal iliac branch embolization (Type IIa), coiling of afferent and efferent internal iliac vessels (Type IIb) and IIAA packing (Type IIc). The average length of stay for these procedures was 3.8 days. During the mean follow-up of 20.9 months, aneurysm size remained unchanged in all but 4 patients. Reinterventions were necessary in option Type Ib (3/8 pat.) and Type Ia (1/7 pat.) due to extender stent-graft migration (n = 2) or reperfusion leaks (n = 2). We conclude that Iliac artery aneurysms may be successfully and safely treated by a tailored approach using embolization or a combination of embolization and stent-grafting. Long-term CT imaging follow-up is necessary, particularly in patients treated with bifurcated stent-grafts (Type Ib).

Isolated iliac artery aneurysms: A contemporary comparison of endovascular and open repair

“…This is undoubtedly due to the increased number of aneurysms that are incidentally discovered on imaging. Some series, which have followed aneurysm size following endovascular exclusion, have failed to document significant shrinkage in aneurysm sac size 16 although this study and others have demonstrated significant sac shrinkage after repair. 7,8 Therefore, some symptomatic patients may still require open surgical resection to address the compressive etiology of their symptoms.…”

“…15 Endovascular management has offered the ability to deal with the challenges of these deep pelvic structures with minimal morbidity with contemporary series boasting perioperative mortality rates approaching 0%. 7,9,16 Earlier reports on iliac aneurysms cited a relatively high percentage of symptomatic presentation. 5 In this study, only a minority of patients presented with symptoms.…”

Midterm outcome of endovascular repair of ruptured isolated iliac artery aneurysms

“…Renal displacement was recorded in eight patients. There were four Ia, four Ib, five IIb, and one IIa type RIIAAs according to Fahrni et al 6 In three patients with a ruptured common IAAs extending in the internal iliac artery, the common and the internal iliac aneurysm were classified separately because this entity does not exist in the classification according to Fahrni et al…”

“…If needed, multiplanar 2-dimensional reconstructions were obtained for better evaluation of the aneurysmal neck and access arterial anatomy. Aneurysms were classified as type I or II according to Fahrni et al 6 Presence or absence of intraperitoneal hemorrhage, renal displacement, and contrast agent extravasation was recorded. An interdisciplinary panel of interventional radiologists and vascular surgeons used CTA results, morphology, and availability of appropriate stent grafts to decide whether the patients were suitable for endovascular repair.…”

Percutaneous common iliac artery aneurysm repair – a case report

“…Preserving the internal iliac arteries is possible only for aneurysmal involvement of the proximal common iliac artery with an adequate distal landing zone available proximal to the origin of the internal iliac artery. Good results from endovascular repair of common iliac artery aneurysms have been reported (4)(5)(6)(7).…”