Endovascular Treatment of Internal Iliac Artery Aneurysms - Single Center Experience

Abstract

ObjectiveInternal iliac artery aneurysms (IIAA) are rare, representing only 0.3% of aortoiliac aneurysms. Its treatment with open surgery is complex and associated with high morbidity and mortality, which led to increasing application of endovascular solutions. In this study, we aimed to evaluate outcomes of endovascular aneurysm repair (EVAR) of IIAA in one institution.MethodsWe retrospectively reviewed all cases of IIAA treated with endovascular techniques between 2003 and 2014. Endpoints were morbidity, mortality, freedom from pelvic ischemic symptoms (buttock claudication, ischemic colitis, and spinal cord injury), and need for reintervention.ResultsThere were 16 patients, 13 males and 3 females, with mean age of 75.1±7 years. A total of 20 IIAA (4 cases were bilateral), with mean diameter of 37.9 mm, were treated. EVAR was performed in 13 (81.3%) patients, with associated internal iliac artery's outflow occlusion in 2. Iliac branch device was used in one patient. Two patients underwent endovascular IIAA embolization alone. One patient underwent percutaneous, transgluteal, IIAA embolization. IIAA flow preservation in at least one internal iliac artery was possible in 9 (56.3%) patients. Early mortality was 7% (1 case). Early morbidity was 18.8%. Pelvic ischemic complications occurred in 1 (7%) patient with buttock claudication. Late reintervention was needed in 3 patients, none of them for IIAA related complications.ConclusionEndovascular treatment of IIAA is technically feasible and durable. Although overall morbidity is relatively high, major complications are infrequent and perioperative mortality is low. internal iliac artery flow preservation is technically challenging and, in a significant number of cases, not possible at all.

Giant internal iliac artery aneurysm successfully treated with endovascular stent-graft placement

“…Iliac artery aneurysms, mostly of the common iliac, have an estimated incidence of just 2% of all abdominal aneurysmal diseases [ 2 , 4 , 7 , 8 ]. Isolated IIAA is defined as a twofold diameter increase without coexisting aneurysm at another location and can be characterized as an unusual variant of aortoiliac aneurysm disease, representing only 0.3% of all aortoiliac aneurysms and a general population prevalence of 0.03% based on large autopsy series [ 1–4 , 6 ]. Most of the IIAAs are diagnosed in association with other intra-abdominal aneurysms [ 8 ].…”

“…Most of the IIAAs are diagnosed in association with other intra-abdominal aneurysms [ 8 ]. Institutional data reveal that IIAAs are present in 10.2% of patients with aortoiliac aneurysms [ 1 ]. Most common etiologic factor for developing IIAA is a degenerative process of the vascular wall mainly associated with arteriosclerosis, while other conditions, such as infection, trauma, connective tissue and arterial wall disorders, and rarely traumatic childbirth, high forceps deliveries, or Caesarian section, have been implicated in the pathogenesis [ 2 , 3 , 6–8 ].…”

“…Patients with IIAA are usually elderly males occurring in the seventh to eighth decade of life (mean age: 75.1 ± 7 years) with a male to female ratio of 6:1 [ 1–3 ]. The vast majority of patients remain asymptomatic until rupture symptoms occur.…”

“…Untreated IIAAs continue expansion with an average rate of aneurysm growth up to 4 mm/year [ 1 ]. In our case, IIAA expanded from 16 mm in 2009 up to 161 mm 8 years later.…”

“…Internal iliac artery aneurysms (IIAAs) are relatively rare and should be treated over a size of 30–40 mm [ 1–5 ]. They usually remain asymptomatic until rupture [ 2, 3 ].…”