Does the presence of an iliac aneurysm affect outcome of endoluminal aaa repair? An analysis of 336 cases

Objective: to determine whether the presence of an iliac aneurysm compromises outcome of endovascular exclusion of AAA and to ascertain the fate of the iliac aneurysmal sac. Patients and methods: between April 1997 and March 2001, data on 336 consecutive patients undergoing endovascular repair for AAA were entered in a prospective database. Suitability for endovascular repair was assessed by preoperative contrast-enhanced computed tomography. A maximum common iliac artery (CIA) diameter ≥20 mm was defined as iliac aneurysm. Patients with and without iliac aneurysms were compared to early (immediate conversion or perioperative death) and late failure (increase in aneurysm diameter or persisting graft-related endoleak, or late AAA rupture or conversion). Results: fifty-nine patients (18%) had iliac aneurysms, 19 were bilateral, for a total of 78 aneurysmal iliac arteries (median diameter 23 mm; range 20–50 mm). A distal seal was achieved by landing in 33 external iliac arteries, in 20 ectatic CIAs, and in 25 normal CIAs. Operating time differed significantly between patients with and without CIA aneurysms (153±71 vs 123±55 min,p =0.0001), whereas no statistically significant differences were found with respect to early and late failure (2% vs 3%, p=0.5 and 14% vs 8%, p=0.11, respectively). There were no cases of buttock or colon necrosis. At a median follow-up of 14 months (range 0–46; i.q.r. 7–27 months) common iliac diameter decreased ≥2 mm in 49 cases, remained stable in 25, and increased ≥2 mm in 3. Conclusion: the presence of iliac aneurysm rendered endoluminal AAA repair more complex but did not affect feasibility and long-term outcome of the procedure. In our experience internal iliac exclusion was never associated with significant morbidity. These data may be useful when considering endovascular repair in high-risk patients with challenging anatomy.