Single-center experience in the endovascular management of isolated iliac artery aneurysm

Abstract

BACKGROUND: Isolated iliac artery aneurysms (IAA) are relatively uncommon and represent 2-7% of all intra-abdominal aneurysms. Surgery is the gold standard treatment for IAA. However, endovascular stent-graft placement is gaining acceptance as an alternative to surgery especially in patients with high surgical risk. PURPOSE: To evaluate the effectiveness and safety of endovascular management of isolated IAA having various anatomic and pathologic bases. MATERIAL AND METHODS: Between 2008 and 2011, 31 patients who underwent endovascular treatment for isolated IAA were retrospectively analyzed. The mean aneurysm size was 43 mm (range, 30-71 mm). The age ranged from 37 to 87 years (mean, 70.0 years). Isolated IAAs were treated in one of three different ways: (i) infrarenal aortic stent-graft placement with limb extension; (ii) stent-graft placement for isolated iliac artery coverage; and (iii) embolization with a coil and a vascular plug combined with femoral-femoral bypass grafting. All patients were assessed by contrast-enhanced computed tomography (CT). The mean follow-up period was 25.1 months (range, 1-60 months). RESULTS: Common iliac artery involvement was seen in 28 patients. Ten (35.7%) of those patients also had an internal IAA. Three patients had an isolated internal IAA. Infrarenal stent-graft placement was performed in 25 patients. Stent-graft placement for coverage of the only iliac artery was performed in five patients. One patient, who had a mycotic aneurysm of the right common iliac artery underwent coil embolization of the ipsilateral common iliac artery with concurrent femoral-femoral bypass graft. Five of the 31 patients (16.1%) with stent grafts had type II endoleaks at the time of the last imaging study, one of those patients underwent percutaneous embolization with glue. None of the patients showed major procedure-related complications. CONCLUSION: Percutaneous management of IAA is effective and safe with various techniques depending on the anatomical and pathologic features of the isolated IAA.