Chapter 77 - Isolated Iliac Artery Aneurysms and their Management

Abstract

Isolated iliac aneurysms are uncommon with an incidence of <2% in the general population. Detection occurs incidentally during imaging indicated for other reasons. Symptomatic or large iliac aneurysms greater than 3.5 cm in diameter can be electively repaired safely with open, endovascular, or hybrid techniques. Surgical treatment repairs and excludes the aneurysm with primary reconstruction or preservation of the internal iliac artery to minimize pelvic ischemia and buttock claudication. Endovascular repair has largely become the first-line treatment modality in patients with suitable anatomy, given its reduction of in-hospital morbidity and mortality along with reduced length of stay. Successful endovascular management requires high-resolution preoperative cross-sectional imaging, usually with computed tomography (CT) angiography, for detailed case planning. Short- and mid-term outcomes for endovascular repair using newer iliac branch stent graft devices that maintain flow to both the external and internal iliac artery are promising, with acceptable initial technical success rates and durability as compared to techniques involving unilateral or bilateral internal iliac artery occlusion. Nevertheless, in situations where internal iliac artery patency is essential and a complex anatomy is not amenable to these devices, open surgical repair may be the preferred modality. Knowledge of all current devices and hybrid techniques allows for excellent outcomes for almost any patient, regardless of anatomic limitations, when applied in a creative and innovative fashion.