From the Guidelines
Management of a 3cm aneurysmal dilation of the common iliac artery typically involves surveillance rather than immediate intervention. For aneurysms of this size, regular monitoring with ultrasound or CT angiography every 6-12 months is recommended to assess for growth, as evidenced by the 2022 ACC/AHA guideline for the diagnosis and management of aortic disease 1. Intervention is generally indicated when the aneurysm reaches 3.5-4cm in diameter, grows more than 0.5cm in 6 months, or becomes symptomatic.
Key Considerations
- The average growth rate of common iliac artery aneurysms is 2.9 mm/y, and no iliac aneurysm ≤3.8 cm ruptured in a large single-center case series 1.
- A multinational retrospective review found that 41.7% of individuals with internal iliac artery aneurysms had a concomitant AAA, and only 1 patient presented with a ruptured internal iliac artery aneurysm of ≤3 cm 1.
- The median iliac artery aneurysm size at elective repair was 4.3 cm, while ruptured iliac aneurysms had a median diameter of 6.8 cm at presentation, according to the Dutch Surgical Aneurysm Audit 1.
Medical Management
When intervention is needed, endovascular repair with stent grafts is the preferred approach for most patients due to lower perioperative morbidity compared to open surgical repair. Medical management should focus on cardiovascular risk factor modification, including:
- Smoking cessation
- Blood pressure control (target <140/90 mmHg)
- Statin therapy (e.g., atorvastatin 20-80mg daily)
- Antiplatelet therapy (aspirin 81mg daily) Beta-blockers may be beneficial in patients with hypertension, as they address the underlying atherosclerotic process and may slow aneurysm growth. Patients should be educated about symptoms that warrant immediate medical attention, including new abdominal or back pain, which could indicate expansion or rupture of the aneurysm.
From the Research
Management of 3cm Aneurysmal Dilation of the Common Iliac Artery
- The management of a 3cm aneurysmal dilation of the common iliac artery is a topic of interest in vascular surgery, with various studies exploring the best approaches for treatment 2, 3, 4, 5, 6.
- According to a study published in 1998, common iliac artery aneurysms measuring ≥ 3 cm in size probably warrant surgical treatment, at which time simultaneous aortic replacement also should be a serious consideration 2.
- A study from 2009 compared open vs. endovascular repair of isolated iliac artery aneurysms and found that endovascular repair is a safe and effective alternative to open repair with mid-term follow-up 3.
- Another study published in 2021 reported on the surgical and endovascular management of isolated internal iliac artery aneurysms, finding that endovascular treatment is the preferred method of treatment in literature, offering good short- to mid-term results and low early mortality 4.
- A 2019 study compared open versus endovascular repair of isolated iliac artery aneurysms and found that both methods can be safely and effectively used, although freedom from reintervention is significantly lower after endovascular repair 5.
- A case report from 2018 presented a customized endovascular technique for repairing common iliac artery aneurysms using an iliac branch device, highlighting the potential for complex endovascular techniques in treating these aneurysms 6.
Treatment Options
- Surgical treatment: may be considered for aneurysms measuring ≥ 3 cm in size, with simultaneous aortic replacement as a serious consideration 2.
- Endovascular repair: a safe and effective alternative to open repair, with mid-term follow-up 3.
- Open repair: can be safely performed with good outcomes, but may have higher morbidity compared to endovascular repair 5.
- Customized endovascular techniques: may be used to repair complex common iliac artery aneurysms, such as those without a proximal seal zone 6.