Iliac artery aneurysm
- Melissa L Kirkwood, MD
Melissa L Kirkwood, MD
- Assistant Professor of Surgery
- UT Southwestern Medical Center
- Section Editors
- John F Eidt, MD
John F Eidt, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor of Surgery
- University of South Carolina School of Medicine Greenville
- Joseph L Mills, Sr, MD
Joseph L Mills, Sr, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor and Chief
- Division of Vascular Surgery and Endovascular Therapy
- Baylor College of Medicine
Aneurysmal degeneration of the iliac arteries (common, internal, external iliac) can occur in isolation, or in association with other large vessel aneurysms (eg, abdominal aorta, femoral artery).
Iliac artery aneurysms (IAAs) are often diagnosed as a result of screening or other imaging studies. Symptoms do not typically occur unless the aneurysm is large and are primarily related to compression of surrounding structures. Like abdominal aortic aneurysms, IAAs have a propensity for life-threatening rupture as diameter increases. On occasion, aneurysm thrombosis may lead to peripheral thromboembolism or acute limb ischemia.
The management of asymptomatic IAAs depends upon the size of the aneurysm, the presence or absence of coexisting abdominal aortic aneurysm or other aneurysm (eg, femoral, popliteal), and patient comorbidities. Patients with symptomatic IAAs should be referred for prompt vascular evaluation and repair.
The diagnosis and management of IAAs will be reviewed here. The surgical and endovascular management of IAAs is reviewed elsewhere. (See "Surgical and endovascular repair of iliac artery aneurysm".)
Seventy percent of iliac aneurysms occur in the common iliac artery, while 20 and 10 percent are found in the internal and external iliac arteries, respectively . About two-thirds of patients with IAA have involvement of more than one segment of the iliac arterial tree; one-third of IAAs are bilateral .
- Krupski WC, Selzman CH, Floridia R, et al. Contemporary management of isolated iliac aneurysms. J Vasc Surg 1998; 28:1.
- Richardson JW, Greenfield LJ. Natural history and management of iliac aneurysms. J Vasc Surg 1988; 8:165.
- Sandhu RS, Pipinos II. Isolated iliac artery aneurysms. Semin Vasc Surg 2005; 18:209.
- Johnston KW, Rutherford RB, Tilson MD, et al. Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg 1991; 13:452.
- Horejs D, Gilbert PM, Burstein S, Vogelzang RL. Normal aortoiliac diameters by CT. J Comput Assist Tomogr 1988; 12:602.
- Bacharach JM, Slovut DP. State of the art: management of iliac artery aneurysmal disease. Catheter Cardiovasc Interv 2008; 71:708.
- Brunkwall J, Hauksson H, Bengtsson H, et al. Solitary aneurysms of the iliac arterial system: an estimate of their frequency of occurrence. J Vasc Surg 1989; 10:381.
- Levi N, Schroeder TV. Isolated iliac artery aneurysms. Eur J Vasc Endovasc Surg 1998; 16:342.
- Chithra R, Sundar RA, Velladuraichi B, et al. Pediatric isolated bilateral iliac aneurysm. J Vasc Surg 2013; 58:215.
- Patel NV, Long GW, Cheema ZF, et al. Open vs. endovascular repair of isolated iliac artery aneurysms: A 12-year experience. J Vasc Surg 2009; 49:1147.
- Huang Y, Gloviczki P, Duncan AA, et al. Common iliac artery aneurysm: expansion rate and results of open surgical and endovascular repair. J Vasc Surg 2008; 47:1203.
- Appel N, Duncan JR, Schuerer DJ. Percutaneous stent-graft treatment of superior mesenteric and internal iliac artery pseudoaneurysms. J Vasc Interv Radiol 2003; 14:917.
- Ijaz S, Geroulakos G. Ruptured internal iliac artery aneurysm mimicking a hip fracture. Int Angiol 2001; 20:187.
- Kalko Y, Basaran M, Aydin U, et al. The surgical treatment of arterial aneurysms in Behçet disease: a report of 16 patients. J Vasc Surg 2005; 42:673.
- Atsuta Y, Inaba M, Goh K, et al. Isolated iliac artery aneurysm caused by fibromuscular dysplasia: report of a case. Surg Today 2003; 33:639.
- Crivello MS, Porter DH, Kim D, et al. Isolated external iliac artery aneurysm secondary to cystic medial necrosis. Cardiovasc Intervent Radiol 1986; 9:139.
- Woodrum DT, Welke KF, Fillinger MF. Candida infection associated with a solitary mycotic common iliac artery aneurysm. J Vasc Surg 2001; 34:166.
- Jacob T, Hingorani A, Ascher E. Examination of the apoptotic pathway and proteolysis in the pathogenesis of popliteal artery aneurysms. Eur J Vasc Endovasc Surg 2001; 22:77.
- Santilli SM, Wernsing SE, Lee ES. Expansion rates and outcomes for iliac artery aneurysms. J Vasc Surg 2000; 31:114.
- Armon MP, Wenham PW, Whitaker SC, et al. Common iliac artery aneurysms in patients with abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 1998; 15:255.
- Henretta JP, Karch LA, Hodgson KJ, et al. Special iliac artery considerations during aneurysm endografting. Am J Surg 1999; 178:212.
- Parlani G, Zannetti S, Verzini F, et al. Does the presence of an iliac aneurysm affect outcome of endoluminal AAA repair? An analysis of 336 cases. Eur J Vasc Endovasc Surg 2002; 24:134.
- Wyers MC, Schermerhorn ML, Fillinger MF, et al. Internal iliac occlusion without coil embolization during endovascular abdominal aortic aneurysm repair. J Vasc Surg 2002; 36:1138.
- Kritpracha B, Pigott JP, Price CI, et al. Distal internal iliac artery embolization: a procedure to avoid. J Vasc Surg 2003; 37:943.
- Richards T, Dharmadasa A, Davies R, et al. Natural history of the common iliac artery in the presence of an abdominal aortic aneurysm. J Vasc Surg 2009; 49:881.
- Ballotta E, Da Giau G, Gruppo M, et al. Natural history of common iliac arteries after aorto-aortic graft insertion during elective open abdominal aortic aneurysm repair: a prospective study. Surgery 2008; 144:822.
- Falkensammer J, Hakaim AG, Andrew Oldenburg W, et al. Natural history of the iliac arteries after endovascular abdominal aortic aneurysm repair and suitability of ectatic iliac arteries as a distal sealing zone. J Endovasc Ther 2007; 14:619.
- Wilhelm BJ, Sakharpe A, Ibrahim G, et al. The 100-year evolution of the isolated internal iliac artery aneurysm. Ann Vasc Surg 2014; 28:1070.
- McCready RA, Pairolero PC, Gilmore JC, et al. Isolated iliac artery aneurysms. Surgery 1983; 93:688.
- Lowry SF, Kraft RO. Isolated aneurysms of the iliac artery. Arch Surg 1978; 113:1289.
- Kato T, Takagi H, Kawai N, et al. Ruptured isolated external iliac artery true aneurysm associated with cystic medial necrosis: report of a case. Surg Today 2009; 39:705.
- Kasulke RJ, Clifford A, Nichols WK, Silver D. Isolated atherosclerotic aneurysms of the internal iliac arteries: report of two cases and review of literature. Arch Surg 1982; 117:73.
- Nelson RP. Isolated internal iliac artery aneurysms and their urological manifestations. J Urol 1980; 124:300.
- Srirangam SJ, Manikandan R, Ross D, Collins GN. Ureteric obstruction caused by aneurysm of the hypogastric artery. Scand J Urol Nephrol 2003; 37:364.
- Nachbur BH, Inderbitzi RG, Bär W. Isolated iliac aneurysms. Eur J Vasc Surg 1991; 5:375.
- Bolin T, Lund K, Skau T. Isolated aneurysms of the iliac artery: what are the chances of rupture? Eur J Vasc Surg 1988; 2:213.
- JACKMAN RJ, McQUARRIE HB, EDWARDS JE. Fatal rectal hemorrhage caused by aneurysm of the internal iliac artery; report of case. Proc Staff Meet Mayo Clin 1948; 23:305.
- JOSHI DM, KELLY M. Rectally palpable aneurysm as a cause of bleeding per rectum. Br J Clin Pract 1963; 17:399.
- Krupski WC, Bass A, Rosenberg GD, et al. The elusive isolated hypogastric artery aneurysm: novel presentations. J Vasc Surg 1989; 10:557.
- de Donato G, Neri E, Baldi I, Setacci C. Rupture of internal iliac artery aneurysm presenting as rectus sheath hematoma: case report. J Vasc Surg 2004; 39:250.
- FRANK IN, THOMPSON HT, ROB C, SCHWARTZ SI. Aneurysm of the internal iliac artery. Arch Surg 1961; 83:956.
- Desiron Q, Detry O, Sakalihasan N, et al. Isolated atherosclerotic aneurysms of the iliac arteries. Ann Vasc Surg 1995; 9 Suppl:S62.
- Schroeder RA, Flanagan TL, Kron IL, Tribble CG. A safe approach to the treatment of iliac artery aneurysms. Aortobifemoral bypass grafting with exclusion of the aneurysm. Am Surg 1991; 57:624.
- Morris ME, Huber KM, Maijub JG. Ruptured hypogastric artery aneurysms: a contemporary review. Vasc Endovascular Surg 2013; 47:239.
- Verta MJ Jr, Janevicius RV. Isolated hypogastric artery aneurysms. J Cardiovasc Surg (Torino) 1982; 23:432.
- Boyarsky AH, Burks WP, Davidson JT, Chandler JJ. Ruptured aneurysm of the internal iliac artery. South Med J 1985; 78:1356.
- Hechelhammer L, Rancic Z, Pfiffner R, et al. Midterm outcome of endovascular repair of ruptured isolated iliac artery aneurysms. J Vasc Surg 2010; 52:1159.
- Ferreira J, Canedo A, Brandão D, et al. Isolated iliac artery aneurysms: six-year experience. Interact Cardiovasc Thorac Surg 2010; 10:245.
- Dix FP, Titi M, Al-Khaffaf H. The isolated internal iliac artery aneurysm--a review. Eur J Vasc Endovasc Surg 2005; 30:119.
- Parry DJ, Kessel D, Scott DJ. Simplifying the internal iliac artery aneurysm. Ann R Coll Surg Engl 2001; 83:302.
- Päivänsalo M, Lähde S, Leinonen A. Bilateral isolated internal iliac aneurysms presenting as pelvic tumours. Rontgenblatter 1987; 40:360.
- Weimann S, Tauscher T, Flora G. Isolated iliac artery aneurysms. Ann Vasc Surg 1990; 4:297.
- Schellack J, Smith RB 3rd, Perdue GD. Nonoperative management of selected popliteal aneurysms. Arch Surg 1987; 122:372.
- Kasirajan V, Hertzer NR, Beven EG, et al. Management of isolated common iliac artery aneurysms. Cardiovasc Surg 1998; 6:171.
- Hassen-Khodja R, Feugier P, Favre JP, et al. Outcome of common iliac arteries after straight aortic tube-graft placement during elective repair of infrarenal abdominal aortic aneurysms. J Vasc Surg 2006; 44:943.
- Kirkwood ML, Saunders A, Jackson BM, et al. Aneurysmal iliac arteries do not portend future iliac aneurysmal enlargement after endovascular aneurysm repair for abdominal aortic aneurysm. J Vasc Surg 2011; 53:269.
- ANATOMIC ISSUES
- Definition of iliac aneurysm
- EPIDEMIOLOGY AND RISK FACTORS
- PATHOGENESIS AND NATURAL HISTORY
- Aneurysm formation
- Iliac artery expansion
- Isolated iliac artery aneurysms
- - Iliac artery aneurysms with coexistent abdominal aortic aneurysms
- Site of aneurysm and association with other aneurysms
- CLINICAL PRESENTATION
- Compression of surrounding structures
- Aneurysm thrombosis and thromboembolism
- Physical examination
- Aneurysm size
- Coexistent AAA
- Indications for repair
- Surveillance ultrasound
- SUMMARY AND RECOMMENDATIONS