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Common Iliac Artery Aneurysm: Expansion Rate And Results Of Open Surgical And Endovascular Repair

Ying Huang, Peter Gloviczki, Audra A Duncan, Manju Kalra, Tanya L Hoskin, Gustavo S Oderich, Thomas C Bower.
Division of Vascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester, MN.

OBJECTIVES: This study assessed expansion rate of common iliac artery aneurysms (CIAAs) and defined outcome after open surgical (OR) and endovascular repair (EVAR).

METHODS: Clinical data of 438 patients with 715 CIAAs treated between 1986 and 2005 were retrospectively reviewed. Size, presentations, and outcomes were recorded. Chi-square test and Kaplan-Meier method with log-rank tests were used for analysis. Mean follow-up was 3.5 years (range: 30 days - 17.5 years).

RESULTS: 412 males (94%), 26 females (6%) underwent interventions for 715 CIAAs (median diameter: 4cm, range: 2-13cm); 152 (35%) had unilateral, 286 (65%) had bilateral CIAAs. 377 patients (633 CIAAs) had current or previously repaired AAA (Group 1), 15 (24 CIAAs) had internal iliac artery aneurysm (IIAA) (Group 2), 46 patients had 58 isolated CIAA (Group 3). Median expansion rate of 104 CIAAs with at least two imaging studies was 0.29cm/year. 125 patients (29%) were symptomatic. The CIAA ruptured in 18 patients (4%, median diameter: 6cm, range: 3.8-8.5cm); five (28%) had iliocaval arteriovenous fistulae. 396 patients had elective, 37 had emergency repairs (18 CIAA ruptures, 14 AAA ruptures, 2 aortic false aneurysms, 1 thrombosis, 1 hematoma, 1 abdominal pain). OR was performed for 648 (91%), EVAR for 67 (9%) CIAAs. 30 day mortality after OR was 1% for elective, 27% for emergency repair. No mortality occurred after OR of arteriovenous fistula. Major complications were more frequent after emergent than elective repair (P<.05) and after OR vs. EVAR (P<.05). 5-year patency was 99.6% (Group 1-3, P=NS; OR: 99.6%, EVAR: 100%, P=NS). 5-year mortality was 66% (Group 1-3, P=NS; OR: 66%, EVAR: 40%, P=NS; elective: 69%, emergent: 37%, P<.0001).

CONCLUSIONS: Expansion rate of CIAAs was 0.29cm/year and no aneurysm < 3.8 cm ruptured. The risk of iliocaval fistula in patients with ruptured CIAA was high (28%), but results of OR for fistula were excellent in spite of high mortality of OR for ruptured CIAA. For non-ruptured CIAA, both OR and EVAR are safe and durable, although complications are higher after OR. Outcomes were similar in patients with or without a concomitant AAA or IIAA.