Aneurysms of the iliac system affect the common iliac artery (CIA) most often and can occur in isolation or in association with abdominal aortic aneurysm (AAA). Iliac artery aneurysm presents in a variety of ways. About half of patients are asymptomatic, and the remaining patients have symptoms related to thromboembolism or to compression of surrounding pelvic structures by the aneurysm. The primary goal of treatment is to prevent iliac artery rupture, which is associated with high mortality rates . When iliac artery aneurysm repair is indicated, an open surgical or endovascular approach can be used. The choice of repair depends upon the clinical presentation, location of the aneurysm, coexistent abdominal aortic aneurysm, and patient comorbidities.
Open surgical and endovascular repair of iliac artery aneurysm will be reviewed here. The clinical evaluation and diagnosis of iliac artery aneurysm are discussed in detail elsewhere. (See "Iliac artery aneurysm".)
INDICATIONS FOR REPAIR
Surgical or endovascular repair of iliac artery aneurysm (IAA) is indicated under the following circumstances (see "Iliac artery aneurysm", section on 'Clinical presentation' and "Iliac artery aneurysm", section on 'Management')
- Ruptured IAA
- Symptomatic IAA
- Rapidly expanding IAA (≥7 mm in six months or >1 cm in one year)
- Asymptomatic IAA ≥3.0 cm
- Coexistent AAA repair
An understanding of the pelvic arterial circulation and its rich network of collaterals is important for treating aneurysms of the iliac artery system.