Large diameter limbs for dilated common iliac arteries in endovascular aneurysm repair: is it safe?

In this prospective study we examined whether dilated common iliac arteries (CIAs) can provide a safe distal seal in endovascular aneurysm repair (EVAR) with the use of bifurcated stent grafts with large diameter limbs. Sixteen patients with 26 dilated CIAs with a diameter of > or =6 mm who were offered EVAR using stent grafts with large diameter limbs were included in the study (Group A). Forty-two patients who also underwent EVAR without iliac dilatation, matched for age, sex and surgical risk were used for comparison (controls-Group B). In group A mean CIA diameter was 18.2 mm (16-28) and mean abdominal aortic aneurysm (AAA) diameter was 6.87 +/- 1.05 cm; mean age was 77.2 +/- 4.8 yrs (67-81). Mean follow-up was 33.6 months (2.8 yrs). CIA diameter changes and development of endoleaks were assessed by CT angiography (CTA). Overall iliac dilatation was present in 16/58 of our patients (27.6%). In 10 patients dilatation was bilateral (17.3%). Partial or complete flow to the internal iliac artery (IIA) territories was preserved in all patients post-EVAR. On follow-up, stable caliber of the dilated CIAs was observed in 21 patients (84%), enlargement of 1mm in 3 (16%), and failure of the distal attachment in 1 (6.2%). Compared to the control group there was no statistical significance in the incidence of complications. Dilated common iliac arteries provide a safe distal seal in patients who have undergone EVAR, thus obviating the need for additional endovascular procedures and sparing flow in the IIA vascular bed.