Staged Endovascular Repair of Isolated Bilateral Internal Iliac Artery Aneurysms: A Case Report

Abstract

This report aims to present an unusual case with isolated bilaterally located internal iliac artery aneurysms (IIAAs) that were incidentally detected. Owing to the high surgical risk of the patient and anatomical location of the aneurysms, an endovascular management was preferred. Initially, the patient underwent a percutaneous embolization of the right-sided aneurysm with coiling. A stent-graft deployment covering the orifice of the left-sided internal iliac artery and occluding the ipsilateral aneurysm followed 1?month later. The patient remains asymptomatic after 6 months. Endovascular management has been associated with lower morbidity and hospital stay compared with open repair for IIAAs, although both techniques show satisfying early and mid-term results. Especially for bilaterally located aneurysms, a staged strategy decreases the risk for ischemic complications. Finally, endovascular methods should be preferred when there are no compression symptoms or in cases of higher surgical risk.

Bilateral GORE Iliac Branch Endoprosthesis with prior open abdominal aortic aneurysm repair

“…Studies have shown that in endovascular aneurysm repairs for AAAs with concomitant IIAA repair as well as in isolated IIAA repair, preservation of both internal iliac arteries is associated with significantly lower rates of buttock claudication compared with preserving one internal iliac artery 7, 8. Another consideration is the timing of the procedures; successful staged endovascular repair of bilateral IIAAs has been reported 12 . Our patient was keen to avoid an additional operation and decided to proceed with the off-label use of the IBEs to reduce the risks of pelvic ischemic complications.…”