Hybrid repair of isolated internal iliac artery aneurysm

Outcome of endovascular treatment of internal iliac artery aneurysms: a single center retrospective review

PURPOSE

To evaluate the technical feasibility and clinical outcomes of endovascular treatment for internal iliac artery (IIA) aneurysms.

MATERIAL AND METHODS

This was a retrospective analysis of 25 patients with 32 IIA aneurysms (mean diameter: 39.1 ± 12.6 mm) who underwent endovascular treatment over a 10-year period, and were available for follow-up. Univariate analysis was used to determine the association between variables (including aortoiliac involvement and technique) and outcome.

RESULTS

The IIA inflow was covered with an iliac stent graft (N = 29) or embolized with a plug (N = 3). The IIA outflow was embolized in all but one case in which there was thrombotic occlusion of outflow branches. Outflow embolization using plugs or coils was performed in the distal IIA or anterior/posterior trunks in 9 cases and distal IIA branches in 22 cases. During a mean follow-up period of 39.9 months, 31.2% of aneurysms demonstrated endoleak and 12.5% demonstrated enlargement. Univariate analysis revealed that endoleak was associated with technical failure (p = 0.01) and that endoleak rate was higher in patients who underwent distal IIA branch embolization (p = 0.03). No variable was associated with sac expansion. Major complication occurred in one patient who died from aneurysm rupture. Minor complications were reported in six patients who developed femoral pseudoaneurysm (N = 2, 8%), buttock claudication (N = 3, 12%), and limb graft occlusion (N = 1, 4%).

CONCLUSION

Endovascular treatment of IIA aneurysms effectively prevents sac expansion. Endoleak was more frequently observed in cases of technical failure and those in which distal IIA branches were embolized.

LEVEL OF EVIDENCE

Level 3b, retrospective cohort study.

Hybrid Treatment of an Enlarging Hypogastric Aneurysm Previously Excluded During Abdominal Aortic Aneurysm Repair

Hypogastric aneurysm is rare, often asymptomatic, but associated with high mortality if it ruptures. Given the deep location of the artery and proximity to critical anatomical structures (i.e., ureter, bladder, and rectum), open surgical repair carries high morbidity and mortality compared with an endovascular approach. We report a simple hybrid approach to repair an enlarging isolated hypogastric aneurysm after a previous aortic aneurysm repair during which the origin of the hypogastric artery was ligated.