CONTEMPORARY MANAGEMENT OF ISOLATED ILIAC ANEURYSMS

Objective: Because isolated common iliac artery aneurysms are infreque nt, are difficult to detect and treat, and have traditionally been ass ociated with high operative mortality rates in reported series, we ana lyzed the outcomes of operative repair of 31 isolated common iliac art ery aneurysms in 21 patients to ascertain morbidity and mortality rate s with contemporary techniques of repair. Methods: A retrospective rev iew study was conducted in a university teaching hospital and a Depart ment of Veterans Affairs Medical Center. Perioperative mortality and o perative morbidity rates were examined in 17 men and four women with i solated common iliac artery aneurysms between 1984 and 1997. Ages rang ed from 38 to 87 years (mean 69 +/- 8 years). Slightly more than half of the cases were symptomatic, with abdominal pain, neurologic, claudi cative, genitourinary, or hemodynamic symptoms. One aneurysm had ruptu red and one was infected. There was one iliac artery-iliac vein fistul a. All aneurysms involved the common iliac artery. Coexistent unilater al 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 cn). 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 pla cement of coils within the aneurysm to occlude it in conjunction with a femorofemoral bypass graft. Patients with bilateral aneurysms underw ent aortoiliac or aortofemoral interposition grafts, whereas unilatera l aneurysms were managed with local interposition grafts. There were n o deaths in the perioperative period. Only one elective operation (5%) resulted in a significant complication, compartment syndrome requirin g fasciotomy. The patient treated with the covered stent required femo rofemoral bypass when the stent occluded 1 week after the operation. T he patient treated with coil occlusion of a large common iliac aneurys m died 2 years later when the aneurysm ruptured. Conclusions: Isolated iliac artery aneurysms can be managed with much lower mortality and m orbidity rates than aneurysm previously been reported by using a syste matic operative approach. Percutaneous techniques may be less durable and effective than direct surgical repair.