MANAGEMENT OF ISOLATED COMMON ILIAC ARTERY ANEURYSMS

Purpose: Since isolated common iliac artery aneurysms are rare and the re is no consensus regarding some aspects of their management, we revi ewed our recorded experience with common iliac artery aneurysms from 1 977 through 1993. Methods: We were able to identify 25 patients having a total of 33 common iliac artery aneurysms on the basis of informati on maintained by our medical records staff, old surgical logs and a de partmental 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 ili ac artery aneurysm repair without aortic replacement (aortic ultrasoun d scans, n = 7) or had no surgical treatment whatsoever (computerized tomography of the abdomen and pelvis, n = 7), Results: 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 ane urysms with mean diameters of 3.8 cm and 5.8 cm, respectively. There w as one postoperative death (5.5%) in conjunction with complementary re nal revascularization in a patient with preoperative renal insufficien cy. During a mean follow-up period of 50 months, two (29%) of the seve n patients who had not received bifurcation grafts at the time of thei r common iliac artery aneurysm procedures had developed infrarenal aor tic aneurysms. Seven (28%) of the original 25 patients were observed w ithout intervention for common iliac artery aneurysms measuring 2-2.5 cm in diameter. No common iliac artery aneurysm enlargement or new aor tic aneurysms have been documented in any of these patients at a mean follow-up interval of 57 months, Conclusions: In our limited experienc e, the risk for spontaneous rupture appears to be concentrated among c ommon iliac artery aneurysms exceeding 5 cm in diameter, while those t hat are less than 3 cm in diameter may fail even to enlarge under obse rvation. Therefore, common iliac artery aneurysms measuring greater th an or equal to 3 cm in size probably warrant surgical treatment, at wh ich time simultaneous aortic replacement also should be a serious cons ideration. (C) 1998 The International Society for Cardiovascular Surge ry. Published by Elsevier Science Ltd. All rights reserved.