Endovascular repair for iliac artery aneurysms

Abstract

• Association between aortic dilation and neck size was observed • Radiological analysis revealed type 2 endoleak as dilatation cause in all cases • Several postoperative aneurysm dilatation cases required various preventive measures This study aimed to retrospectively determine the association between aortic dilatation and common iliac artery neck size. Consecutive patients who had undergone elective endovascular aneurysm repair for iliac artery aneurysms (IAAs) from January 2009 to December 2017 were evaluated. Aneurysm dilatations >3 mm were observed in five cases; two cases were LAND+ and three cases were LAND−. Radiological analysis revealed that type 1 and type 2 endoleaks caused dilatations in all cases. In LAND+ cases, endoleaks occurred due to blood inflow from the distal side of the aneurysm due to coil embolization failure, whereas in LAND− cases, endoleaks occurred due to retrograde inflow from the distal side of the internal iliac artery (IIA) and antegrade inflow from the lumbar artery. Decreased IAA diameters were significantly more common in the LAND+ group than in the LAND− group. Endoleaks are the major cause of postoperative dilatation in IAA. The neck size of the common iliac artery was determined to be a crucial factor contributing to postoperative dilation of IAA. Radiological analysis revealed that the endoleaks in the IIA and lumbar artery were responsible for dilatation in all cases. When the portion of the common iliac artery from the terminal aorta to the IAA was <16 mm in diameter, postoperative aneurysms decreased.