Endovascular Treatment Versus Open Surgery for Isolated Iliac Artery Aneurysms: A Systematic Review and Meta-Analysis

Abstract

Objective: The aim of this review was to compare the outcomes of endovascular treatment (ET) versus open surgery (OS) for patients with isolated iliac artery aneurysms (IIAAs). Methods: Studies that reported ET and OS for IIAAs were searched in databases until December 5, 2018. Studies were included for reporting both ET and OS for patients with IIAAs, and at least one of the following outcomes: postoperative mortality, postoperative ischemic complications (PIC), wound complications, blood transfusion, and length of hospital stay (LHS). We adopted Inverse Variance method to calculate the mean difference (MD) of LHS, and adopted Mantel–Haenszel method for odds ratios (ORs) of postoperative mortality, PICs, wound complications, and blood transfusion. Results: Nine studies were included, and all of them were observational studies, 7 studies were available for meta-analysis. When compared with OS, ET was associated with a higher risk of PICs (OR: 3.24, 95% confidence interval [CI]: 1.05-10.02), a lower risk of blood transfusion (OR: 0.22, 95% CI: 0.08-0.58), and a much shorter LHS (MD: −4.39, 95% CI: −6.18 to −2.60). The postoperative mortality and wound complication were similar between groups. Conclusion: Both ET and OS were safe and effective methods to repair IIAAs with similar postoperative mortality. Compared with OS, ET can reduce the need for transfusion and the time of LHS, but it was associated with a higher risk of PICs. The comparisons of primary patency and reintervention rates were still unclear between the 2 groups.

Endovascular Repair of an Isolated Iliac Artery Aneurysm in a Patient with Liver Cirrhosis

“…In a systematic review and meta-analysis containing 7 studies which compared outcomes of open surgery and endovascular repair, Xiang et al showed that both procedures were safe and effective to repair IIAAs with similar postoperative mortality. Compared with open surgery, endovascular treatment can reduce the need for blood transfusion and hospital stay, but it was associated with a higher risk of postoperative ischemic complications [2,7]. We performed an endovascular repair of right common and external iliac arteries and obliteration of right hypogastric artery because of its aneurysmal involvement and prevention of endoleak.…”

“…Isolated iliac artery aneurysms (IIAA) are uncommon and mostly asymptomatic [1]. Endovascular aneurysm repair (EVAR) is the preferred method for therapeutic management of different types of aneurysms since mortality, morbidity, hospital stay and blood loss are less compared to surgical strategy and yet is as effective as open surgery [2]. Elective repair is indicated for common and external iliac artery aneurysms greater than 3-4 centimeters in maximal transverse diameter and 2 centimeters for internal iliac artery repair [3,4].…”

Percutaneous Retrograde Trans-gluteal Embolization Of Type 2 Endoleak Causing Iliac Aneurysm Enlargement After Endovascular Re-pair: Case Report And Literature Review

“…Their persistence, when associated with aneurismal sac expansion represents the most common cause of aneurysm-related reinterventions. Both open and endovascular surgery techniques have been described in this setting and the endovascular approach is nowadays the preferred one in patients with fit anatomy due to its shorter length of post-operative stay and lower morbidity compared with open surgery [3]. Many endovascular options exist aiming to embolize the aneurysmal sac and feeding vessels.…”

Percutaneous Retrograde Trans-Gluteal Embolization of Type 2 Endoleak Causing Iliac Aneurysm Enlargement after Endovascular Repair: Case Report and Literature Review

“…Their persistence, when associated with aneurismal sac expansion, represents the most common cause of aneurysm-related reinterventions. Both open and endovascular surgery techniques have been described in this setting, and the endovascular approach is nowadays the preferred option in patients with fit anatomy due to its shorter length of postoperative stay and lower morbidity compared with open surgery [3]. Many endovascular options exist, aiming to embolize the aneurysmal sac and feeding vessels.…”