Endo Repair Aids In Iliac Aneurysms

By Jeff Evans 

WASHINGTON -- Endovascular repair of iliac artery aneurysms provides a level of safety similar to open repair, but it may require a shorter hospital stay and fewer blood transfusions, Dr. Rabih A. Chaer reported at the annual meeting of the Eastern Vascular Society.

Most patients with iliac artery aneurysms (IAAs) are asymptomatic, but some may present with thrombosis or rupture, which is associated with a high operative mortality, said Dr. Chaer of the division of vascular surgery at New York Presbyterian Hospital.

For that reason, some centers have adopted a policy of elective open or endovascular repair, he said.

Dr. Chaer reviewed the outcomes of 71 IAAs that were treated electively or for rupture with endovascular (52) or elective open repair (19) at New York Presbyterian Hospital during 2000-2006.

The common iliac artery was the most common site for open (68%, 13 of 19) or endovascular repair (77%, 40 of 52) of the aneurysms. Openly repaired patients had a significantly larger mean IAA diameter at the time of the procedure than did those in the endovascular repair group (5.4 cm vs. 4.3 cm).

If the aneurysm involved the origin of the internal iliac artery or if the nonaneurysmal portion of the common iliac artery was not long enough, surgeons embolized the internal iliac artery before placing a stent graft. Aneurysms at distal portions of the internal iliac artery also were embolized. Most patients received a stent graft to cover the origin of the internal iliac artery.

All open repairs were performed with patients under general anesthesia, while regional anesthesia was usually used in endovascular repairs, depending on the surgeon's preference, Dr. Chaer said.

Of three patients who died in the group that underwent open repair, all died perioperatively following rupture. In the endovascular repair group, four patients died, only one of whom died following a rupture.

A significantly higher percentage of openly repaired patients required transfusion (47%, 9 of 19), compared with patients who received an endovascular repair (6%, 3 of 52). Patients who received an open repair also had a significantly longer mean postoperative hospital stay than did endovascularly repaired patients (5.2 days vs. 1.3 days).

Two aneurysms that were initially repaired with a bifurcated stent graft later resulted in limb occlusions, one of which was treated with a bypass while the other was lysed and stented. One type I endoleak and two type II endoleaks occurred. But the overall freedom from secondary interventions was similar between the two treatment groups, according to Dr. Chaer.