Regarding “Aneurysmal iliac arteries do not portend future iliac aneurysmal enlargement after endovascular aneurysm repair for abdominal aortic aneurysm”

Abstract

We would agree with the authors1Kirkwood M.L. Saunders A. Jackson B.M. Wang G.J. Fairman R.M. Woo E.Y. Aneurysmal iliac arteries do not portend future iliac aneurysmal enlargement after endovascular aneurysm repair for abdominal aortic aneurysm.J Vasc Surg. 2011; 53: 269-273Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar that aneurysmal degeneration of the iliac arteries does not occur in either normal or ectactic arteries at the time of endovascular aneurysm repair (EVAR), but only up to 5 years postendovascular repair. We have previously shown2Agu O. Boardley D. Adiseshiah M. Another late complication after endovascular aneurysm repair: aneurysmal degeneration at the iliac artery landing site.Vascular. 2008; 16: 316-320Crossref PubMed Scopus (6) Google Scholar, 3Adiseshiah M. Boardley D. Raphael M.J. Late iliac artery aneurysm formation: implications for the lower landing site after EVAR.J Endovasc Ther. 2008; 15: 246-247Crossref PubMed Scopus (10) Google Scholar, 4Adiseshiah M. Boardley D. Agu O. Raphael M. Twelve-year outcomes after endovascular aneurysm repair using earliest available endograft components from a single center.J Vasc Surg. 2010; 52: 49-54Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar that up to 5 years after EVAR, aneurysmal dilatation does not take place. However, between 5 and 12 years, there is a low (<3%) but definite incidence of aneurysmal dilatation. We too reported that aneurysmal dilatation occurred in arteries of <20-mm diameter. We also reported that the aneurysm formation occurred in arteries, which were the landing site of EVAR, as well as in iliacs that were contralateral to the uni-iliac landing site in that type of reconstruction. We note that the above study ran to only 5 years after EVAR. We would expect a similar incidence of aneurysmal degeneration in the iliacs in this study after 5 years in survivors with intact endografts. Aneurysmal iliac arteries do not portend future iliac aneurysmal enlargement after endovascular aneurysm repair for abdominal aortic aneurysmJournal of Vascular SurgeryVol. 53Issue 2PreviewThe purpose of this study was to examine the fate of aneurysmal iliac arteries managed during endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). Full-Text PDF Open ArchiveReplyJournal of Vascular SurgeryVol. 54Issue 1PreviewWe appreciate the letter by Dr Mohan Adiseshiah. It addresses a limitation of our study in that our follow-up is limited to those data which are collected on the Zenith clinical trial. It certainly would be interesting to see if we had similar results out to 12 years or if the iliac arteries remained stable. Unfortunately, those data are not available. Full-Text PDF Open Archive