Natural history of common iliac arteries after aorto-aortic graft insertion during elective open abdominal aortic aneurysm repair: A prospective study

Abstract

This study aimed to determine the natural history of common iliac arteries (CIAs) after elective open infrarenal abdominal aortic aneurysm (AAA) repair with an aorto-aortic prosthetic graft. All patients who had a straight tube graft inserted during elective AAA repair at our institution between 1995 and 2005 were prospectively followed up with preoperative and postoperative computed tomography (CT) scans to monitor changes in CIA diameter; their latest CT scan was performed in 2007. Based on preoperative CIA diameter, patients were divided into groups A (both CIAs normal, up to 12 mm in diameter), B (at least 1 ectatic CIA, 13-18 mm), and C (at least 1 aneurysmal CIA, 19-25 mm). The mean follow-up was 7.1 years (range, 2.1-12.3 years). Among 201 patients eligible for the study, 92 patients (45.8%) were in group A, 63 patients (31.3%) were in group B, and 46 patients (22.9%) were in group C. Overall, the diameter increased in 119 CIAs (29.6%) by a mean of 1.1, 1.8, and 2.4 mm in groups A, B, and C, respectively. In all, 14 CIAs (5.4%) progressed from "normal" to "ectatic," and 9 CIAs (10.2%) progressed from "ectatic" to "aneurysmal." Three aneurysmal CIAs slightly exceeded the 25-mm threshold, but none of these were repaired. No patients showed a progression or development of occlusive iliac artery disease or required repeat operation because of excessive CIA enlargement. This analysis showed that most CIAs do not expand after tube graft insertion during AAA repair, and when they do, the degree of dilation is minimal. Tube graft insertion during AAA repair is justified even for ectatic or moderately aneurysmal CIAs, and the procedure is safe and durable. The skepticism surrounding its selective use instead of a systematic bifurcated graft placement seems to be unwarranted.