Contemporary Management of Aorto-iliac Aneurysms in the Endovascular Era

Abstract

Up to 40% of abdominal aortic aneurysms have co-existing unilateral or bilateral iliac artery ectasia or aneurysm. These are associated with an increased risk of endoleak, morbidity and mortality following endoluminal repair. To reduce the adverse sequelae of internal iliac artery (IIA) occlusion, various open, endovascular and hybrid measures have been described to maintain perfusion to the pelvis. This review discusses the contemporary management of aorto-iliac aneurysm in the endovascular era with reference to the sequelae of IIA occlusion and the strategies to preserve IIA perfusion. Particular consideration is given to iliac bifurcation devices.

Results of Repair of Iliac Artery Aneurysms with the Sandwich Technique

“…Unfortunately, this leaves a signifi cant number of patients with limiting buttock claudication. Th e risk of this is 16% to 50% if unilateral closure is performed but rises to 80% if bilateral IIA occlusion is done ( 15 ). Th ere are other signifi cant complications related to IIA sacrifi ce.…”

A surgical emergency

“…11 13 14 2 Association with abdominal aortic aneurysms Involvement of the iliac arteries is seen in up to 40% of patients with abdominal aortic aneurysms. 15 Aorto-iliac aneurysms pose particular challenges compared with isolated aortic or iliac aneurysms. 15 Concomitant aortic and iliac aneurysms are associated with an increased prevalence of cardiac, renal, and respiratory comorbidity, in addition to more complex anatomy.…”

“…15 Aorto-iliac aneurysms pose particular challenges compared with isolated aortic or iliac aneurysms. 15 Concomitant aortic and iliac aneurysms are associated with an increased prevalence of cardiac, renal, and respiratory comorbidity, in addition to more complex anatomy. 16 …”

“…Embolisation of the internal iliac artery and exclusion of common and external iliac aneurysms with covered stents are now common necessities. 15 Unilateral and bilateral occlusion of the internal iliac arteries is associated with various complications, including buttock or thigh claudication, sexual dysfunction, colonic ischaemia, perineal necrosis, and acute limb ischaemia. 15 The most common complication of endovascular treatment is a type I endoleak, which occurs in up to 7% of cases, of which 50% go on to rupture.…”

Endovascular Repair of Complex Aortic Pathology

“…In this systematic review, 12 studies included five reports of [64]. Technical success rates for iliac branch devices have been reported as greater than 95 % in several publications, with a clear improvement after the advent of newer generation devices [65][66][67][68][69][70][71]. A systematic analysis by Karthikesalingam and associates [72] included 196 patients treated with IBDs, with technical success rates ranging from 85 to 100 %, with no aneurysm-related deaths.…”