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Straight tube graft replacement of an infrarenal abdominal aortic aneurysm (AAA) is justified even for moderate common iliac artery (CIA) dilatation (smaller than 18 mm in diameter). Bifurcated graft placement during AAA surgery is warranted if preoperative CIA diameters are 25 mm or larger, because they tend to expand more rapidly. The results, presented by researchers from France and Belgium, were published in the November issue of the Journal of Vascular Surgery. 

“The potential of a CIA being between 18 mm and 25 mm in diameter also justifies a bifurcated graft when the patient’s life expectancy is eight years or more,” said Reda Hassen-Khodja, MD, lead author and a professor from the department of vascular surgery at the University Hospital of Nice in France.

“We examined variables that were associated with aneurysmal change in CIA,” added Dr. Hassen-Khodja, “including initial CIA diameter, celiac aorta diameter on the preoperative CT scan, a coexisting aneurysm site and the follow-up duration.”

Hassen-Khodja and his team of researchers studied the relative rates of CIA expansion in 147 patients from five hospitals, who elected to have the procedure. All patients had postoperative CT scans done to assess changes diameter. The mean age of patients, who were mostly men, was 68 years.

Patients were divided into groups based on preoperative CIA diameter. Group A (40.1 percent) had CIA of normal diameter; Group B (36.1 percent) had ectasia, 12 to 18 mm in diameter of at least one CIA; and Group C (23.8 percent) had an aneurysm with a diameter more than 18 mm of at least one CIA.

The diameter of the CIA increased by a mean of 1 mm (9.4 percent) over 5.5 years in Group A; 1.7 mm (12.percent) over 4.3 years in Group B; and 2.3 mm (12.7 percent) over 4.2 years in Group C. Three patients in Group C required repeat surgery during follow-up for a CIA aneurysm. No patient developed occlusive iliac artery disease during follow-up. 

“Tube grafts offer a shorter operative time and reduced intraoperative blood loss, especially in the case of aneurysm rupture,” said Dr. Hassen-Khodja. “Many surgeons believe that they are easier and faster to insert during elective AAA repair, have lower risk of venous and ureteral injury during dissection of the CIA, and have fewer postoperative graft-related complications like thrombosis and false anastomotic aneurysms. Surgeons who perform bifurcated grafts say that these prostheses permit treatment of atherosclerotic aortoiliac disease during the AAA repair and prevent subsequent aneurysmal ICA change.