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Contemporary management of isolated iliac aneurysms
W C Krupski1, C H Selzman, R Floridia
1The Section of Vascular Surgery, University of Colorado Health Sciences Center, and The Denver Department of Veterans Affairs Medical Center, 80262, USA.
Insights
Surgical repair of isolated common iliac artery aneurysms offers improved outcomes. Contemporary techniques demonstrate significantly lower mortality and morbidity rates compared to historical data for these rare aneurysms.
Area of Science:
- Vascular Surgery
- Aneurysm Management
- Surgical Outcomes
Background:
- Isolated common iliac artery aneurysms are rare and associated with high mortality.
- Effective detection and treatment strategies are crucial for improving patient outcomes.
Purpose of the Study:
- To analyze the morbidity and mortality rates of operative repair for isolated common iliac artery aneurysms using contemporary techniques.
- To evaluate the effectiveness of different surgical approaches in managing these aneurysms.
Main Methods:
- Retrospective review of 31 isolated common iliac artery aneurysms in 21 patients (1984-1997).
- Analysis of perioperative mortality and morbidity rates.
- Comparison of outcomes between direct operative repair, endoluminal stent grafts, and percutaneous coil occlusion.
Main Results:
- No perioperative deaths occurred.
- One elective operation (5%) resulted in compartment syndrome.
- Endoluminal stent graft occlusion and coil embolization had less durable outcomes compared to direct repair.
Conclusions:
- A systematic operative approach can significantly reduce mortality and morbidity for isolated common iliac artery aneurysms.
- Direct surgical repair appears more durable and effective than percutaneous techniques.
Objective:
Because isolated common iliac artery aneurysms are infrequent, are difficult to detect and treat, and have traditionally been associated with high operative mortality rates in reported series, we analyzed the outcomes of operative repair of 31 isolated common iliac artery aneurysms in 21 patients to ascertain morbidity and mortality rates with contemporary techniques of repair.
Methods:
A retrospective review study was conducted in a university teaching hospital and a Department of Veterans Affairs Medical Center. Perioperative mortality and operative morbidity rates were examined in 17 men and four women with isolated common iliac artery aneurysms between 1984 and 1997. Ages ranged from 38 to 87 years (mean 69 +/- 8 years). Slightly more than half of the cases were symptomatic, with abdominal pain, neurologic, claudicative, genitourinary, or hemodynamic symptoms. One aneurysm had ruptured and one was infected. There was one iliac artery-iliac vein fistula. All aneurysms involved the common iliac artery. Coexistent unilateral or bilateral external iliac aneurysms were present in four patients; there were three accompanying internal iliac aneurysms. Overall, 52% of patients had unilateral aneurysms and 48% had bilateral aneurysms. Aneurysms ranged in maximal diameter from 2.5 to 12 cm (mean 5.6 +/- 2 cm). No patients were unavailable for follow-up, which averaged 5.5 years.
Results:
Nineteen patients underwent direct operative repair of isolated iliac aneurysms. One patient had placement of an endoluminal covered stent graft; another patient at high risk had percutaneous placement of coils within the aneurysm to occlude it in conjunction with a femorofemoral bypass graft. Patients with bilateral aneurysms underwent aortoiliac or aortofemoral interposition grafts, whereas unilateral aneurysms were managed with local interposition grafts. There were no deaths in the perioperative period. Only one elective operation (5%) resulted in a significant complication, compartment syndrome requiring fasciotomy. The patient treated with the covered stent required femorofemoral bypass when the stent occluded 1 week after the operation. The patient treated with coil occlusion of a large common iliac aneurysm died 2 years later when the aneurysm ruptured.
Conclusions:
Isolated iliac artery aneurysms can be managed with much lower mortality and morbidity rates than aneurysm previously been reported by using a systematic operative approach. Percutaneous techniques may be less durable and effective than direct surgical repair.