Surgical and endovascular repair of 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 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 Surgery
- Professor of Surgery
- University of Arizona Health Sciences Center
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')
- Melas N, Saratzis A, Dixon H, et al. Isolated common iliac artery aneurysms: a revised classification to assist endovascular repair. J Endovasc Ther 2011; 18:697.
- Valentine RJ, Wind GG. Anatomic Exposures in Vascular Surgery, 2nd ed, Lippincott Williams &Wilkins, Philadelphia 2003.
- Gray H. Anatomy of the Human Body. www.bartleby.com/107 (Accessed on December 20, 2011).
- Katsargyris A, Oikonomou K, Klonaris C, et al. Common iliac and hypogastric aneurysms: open and endovascular repair. J Cardiovasc Surg (Torino) 2015; 56:249.
- Yamamoto H, Yamamoto F, Ishibashi K, et al. Long-term outcomes of open surgical repair for ruptured iliac artery aneurysms. Ann Vasc Surg 2011; 25:740.
- Chaer RA, Barbato JE, Lin SC, et al. Isolated iliac artery aneurysms: a contemporary comparison of endovascular and open repair. J Vasc Surg 2008; 47:708.
- Pitoulias GA, Donas KP, Schulte S, et al. Isolated iliac artery aneurysms: endovascular versus open elective repair. J Vasc Surg 2007; 46:648.
- 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.
- 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.
- Dix FP, Titi M, Al-Khaffaf H. The isolated internal iliac artery aneurysm--a review. Eur J Vasc Endovasc Surg 2005; 30:119.
- Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195.
- Chaikof EL, Blankensteijn JD, Harris PL, et al. Reporting standards for endovascular aortic aneurysm repair. J Vasc Surg 2002; 35:1048.
- Bacharach JM, Slovut DP. State of the art: management of iliac artery aneurysmal disease. Catheter Cardiovasc Interv 2008; 71:708.
- Philpott JM, Parker FM, Benton CR, et al. Isolated internal iliac artery aneurysm resection and reconstruction: operative planning and technical considerations. Am Surg 2003; 69:569.
- Dorigo W, Pulli R, Troisi N, et al. The treatment of isolated iliac artery aneurysm in patients with non-aneurysmal aorta. Eur J Vasc Endovasc Surg 2008; 35:585.
- Rana MA, Kalra M, Oderich GS, et al. Outcomes of open and endovascular repair for ruptured and nonruptured internal iliac artery aneurysms. J Vasc Surg 2014; 59:634.
- Fokou M, Teyang A, Fongang E, et al. Surgical repair of a giant isolated inflammatory aneurysm of the left common iliac artery. Ann Vasc Surg 2011; 25:700.e1.
- Sacks NP, Huddy SP, Wegner T, Giddings AE. Management of solitary iliac aneurysms. J Cardiovasc Surg (Torino) 1992; 33:679.
- Nakajima T, Kawazoe K, Komoda K, et al. Failure of exclusion of internal iliac artery aneurysms. J Vasc Surg 2001; 33:476.
- Uberoi R, Tsetis D, Shrivastava V, et al. Standard of practice for the interventional management of isolated iliac artery aneurysms. Cardiovasc Intervent Radiol 2011; 34:3.
- Oderich GS, Tallarita T. Iliac artery aneurysms: implications of a new proposed classification system to standardize reports dealing with endovascular repair. J Endovasc Ther 2011; 18:716.
- 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.
- Ferreira M, Monteiro M, Lanziotti L. Technical aspects and midterm patency of iliac branched devices. J Vasc Surg 2010; 51:545.
- Verzini F, Parlani G, Romano L, et al. Endovascular treatment of iliac aneurysm: Concurrent comparison of side branch endograft versus hypogastric exclusion. J Vasc Surg 2009; 49:1154.
- Wolf F, Loewe C, Cejna M, et al. Endovascular management performed percutaneously of isolated iliac artery aneurysms. Eur J Radiol 2008; 65:491.
- Stroumpouli E, Nassef A, Loosemore T, et al. The endovascular management of iliac artery aneurysms. Cardiovasc Intervent Radiol 2007; 30:1099.
- Malas MB, Robotham D, Qazi U, et al. Endovascular approach to treating common iliac artery aneurysm with contralateral aorto-uni-iliac endograft and a femoral-femoral bypass. J Vasc Interv Radiol 2010; 21:1891.
- Marty B, Perruchoud C, Wicky S, et al. Atheroembolization: a harmful complication of therapeutic internal iliac artery occlusion. J Vasc Surg 2002; 36:1062.
- Mehta M, Veith FJ, Darling RC, et al. Effects of bilateral hypogastric artery interruption during endovascular and open aortoiliac aneurysm repair. J Vasc Surg 2004; 40:698.
- Bratby MJ, Munneke GM, Belli AM, et al. How safe is bilateral internal iliac artery embolization prior to EVAR? Cardiovasc Intervent Radiol 2008; 31:246.
- Engelke C, Elford J, Morgan RA, Belli AM. Internal iliac artery embolization with bilateral occlusion before endovascular aortoiliac aneurysm repair-clinical outcome of simultaneous and sequential intervention. J Vasc Interv Radiol 2002; 13:667.
- Sandhu RS, Pipinos II. Isolated iliac artery aneurysms. Semin Vasc Surg 2005; 18:209.
- Soury P, Brisset D, Gigou F, et al. Aneurysms of the internal iliac artery: management strategy. Ann Vasc Surg 2001; 15:321.
- Cormier F, Al Ayoubi A, Laridon D, et al. Endovascular treatment of iliac aneurysms with covered stents. Ann Vasc Surg 2000; 14:561.
- Boules TN, Selzer F, Stanziale SF, et al. Endovascular management of isolated iliac artery aneurysms. J Vasc Surg 2006; 44:29.
- Sahgal A, Veith FJ, Lipsitz E, et al. Diameter changes in isolated iliac artery aneurysms 1 to 6 years after endovascular graft repair. J Vasc Surg 2001; 33:289.
- Gargiulo NJ 3rd, Veith FJ, Lipsitz EC, et al. Perimalleolar and pedal thromboembolectomy and bypasses to treat distal embolization during aortoiliac aneurysm repairs. J Vasc Surg 2008; 48:43.
- Chowdhury MM, Schiro A, Farquharson F, et al. Treatment of aortoiliac aneurysms with the iliac bifurcated device for preservation of internal iliac artery flow. Vasc Endovascular Surg 2014; 48:153.
- Milite D, Campanile F, Tosato F, et al. Hypogastric artery bypass in open repair of abdominal aortoiliac aneurysm: a safe procedure. Interact Cardiovasc Thorac Surg 2010; 10:749.
- Chemelli A, Hugl B, Klocker J, et al. Endovascular repair of isolated iliac artery aneurysms. J Endovasc Ther 2010; 17:492.
- Rozenblit AM, Cynamon J, Maddineni S, et al. Value of CT angiography for postoperative assessment of patients with iliac artery aneurysms who have received endovascular grafts. AJR Am J Roentgenol 1998; 170:913.
- Kranokpiraksa P, Kaufman JA. Follow-up of endovascular aneurysm repair: plain radiography, ultrasound, CT/CT angiography, MR imaging/MR angiography, or what? J Vasc Interv Radiol 2008; 19:S27.
- INDICATIONS FOR REPAIR
- PELVIC CIRCULATION
- OPEN SURGICAL VERSUS ENDOVASCULAR REPAIR OF ILIAC ARTERY ANEURYSMS
- Antithrombotic therapy
- Prophylactic antibiotics
- Prevention of contrast-induced nephropathy
- OPEN SURGICAL REPAIR
- Common iliac artery aneurysm
- Operative repair of internal iliac artery aneurysm
- ENDOVASCULAR REPAIR
- Associated abdominal aortic aneurysm
- - Branched grafts
- Isolated common iliac artery aneurysm
- Internal iliac artery embolization
- ANEURYSM SURVEILLANCE
- SUMMARY AND RECOMMENDATIONS