Management of isolated common iliac artery aneurysms

Since isolated common iliac artery aneurysms are rare and there is no consensus regarding some aspects of their management, we reviewed our recorded experience with common iliac artery aneurysms from 1977 through 1993.

We were able to identify 25 patients having a total of 33 common iliac artery aneurysms on the basis of information maintained by our medical records staff, old surgical logs and a departmental registry that was implemented in 1989. Follow-up data were collected from outpatient charts and by telephone contact. New imaging studies were obtained for 14 patients who either underwent common iliac artery aneurysm repair without aortic replacement (aortic ultrasound scans, n = 7) or had no surgical treatment whatsoever (computerized tomography of the abdomen and pelvis, n = 7).

All 25 patients were men (mean age, 71 years). Eighteen patients (72%) had elective (n = 14) or urgent (n = 4) operations to repair common iliac artery aneurysms with mean diameters of 3.8 cm and 5.8 cm, respectively. There was one postoperative death (5.5%) in conjunction with complementary renal revascularization in a patient with pre-operative renal insufficiency. During a mean follow-up period of 50 months, two (29%) of the seven patients who had not received bifurcation grafts at the time of their common iliac artery aneurysm procedures had developed infrarenal aortic aneurysms. Seven (28%) of the original 25 patients were observed without intervention for common iliac artery aneurysms measuring 2-2.5 cm in diameter. No common iliac artery aneurysm enlargement or new aortic aneurysms have been documented in any of these patients at a mean follow-up interval of 57 months.

In our limited experience, the risk for spontaneous rupture appears to be concentrated among common iliac artery aneurysms exceeding 5 cm in diameter, while those that are less than 3 cm in diameter may fail even to enlarge under observation. Therefore, common iliac artery aneurysms measuring > or = 3 cm in size probably warrant surgical treatment, at which time simultaneous aortic replacement also should be a serious consideration.