From the Guidelines
A left common iliac artery (CIA) dissection should be treated with blood pressure control, antiplatelet therapy, and close monitoring, with endovascular stenting or surgical intervention reserved for cases with complications or symptoms despite medical management, as recommended by the 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease 1. The treatment approach for a left CIA dissection involves a combination of medical and potential interventional strategies. Medical management typically includes blood pressure control with medications like beta-blockers (metoprolol 25-100mg twice daily) or calcium channel blockers (amlodipine 5-10mg daily), along with antiplatelet therapy such as aspirin (81-325mg daily) 1.
- Key considerations in managing CIA dissection include:
- Blood pressure control to reduce the risk of further dissection or rupture
- Antiplatelet therapy to prevent thrombosis
- Close monitoring with vascular imaging to assess for complications such as aneurysm formation or expansion of the dissection
- Endovascular stenting or surgical intervention for cases with complications or symptoms despite medical management, as these approaches can provide rapid restoration of arterial flow and prevent limb ischemia 1 The 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease provides recommendations for revascularization strategies in patients with acute limb ischemia (ALI), which can be applicable to cases of CIA dissection 1.
- The guideline recommends that the revascularization strategy should be determined by local resources and patient factors, and that catheter-based thrombolysis can be an effective approach for patients with ALI and a salvageable limb 1
In terms of specific treatment approaches, the guideline suggests that:
- Catheter-based thrombolysis is effective for patients with ALI and a salvageable limb
- Amputation should be performed as the first procedure in patients with a nonsalvageable limb
- Patients with ALI should be monitored and treated for compartment syndrome after revascularization
- Percutaneous mechanical thrombectomy can be useful as adjunctive therapy to thrombolysis in patients with ALI and a salvageable limb 1
From the Research
Left CIA Dissection
- Left common iliac artery (CIA) dissection is a rare medical condition, and isolated iliac artery dissection (ISIAD) without the involvement of the aorta is even more uncommon 2.
- A case study reported a 38-year-old man with sudden onset of rest pain and paraesthesia on the right lower limb, who underwent computed tomography angiography, revealing isolated common iliac artery (CIA) dissection, and was treated with endovascular treatment (stenting) of the CIA dissection 2.
- Endovascular treatment of ISIAD is a viable treatment modality, with low periprocedural complications, mortality, and morbidity 2.
- However, there is limited information available on left CIA dissection specifically, and most studies focus on iliac artery dissection in general or other related conditions such as May-Thurner syndrome 3 or aortoiliac occlusive disease (AIOD) 4.
- A systematic review on endovascular repair of isolated common iliac artery aneurysms suggested that endovascular treatment is feasible and safe with a low mortality and excellent technical success rates, but more studies with longer follow-up and reliable long-term results are needed 5.
- Conservative management of uncomplicated asymptomatic iliac artery dissection (IAD) should be considered as first-line therapy, while complicated cases with rupture should be treated on an emergency basis using open and endovascular repairs 6.