What is aneurysm dilation of the iliac arteries?

From the Guidelines

An aneurysm dilation of iliac arteries is a serious condition that requires prompt attention, and elective repair of both abdominal and iliac aneurysms is recommended for patients with asymptomatic small AAA and concomitant common iliac artery aneurysm(s) ≥3.5 cm. This condition occurs when the arterial wall weakens, allowing the vessel to expand beyond its normal diameter, and is often asymptomatic until they reach a significant size, typically greater than 3 cm in diameter 1. The prevalence of common iliac artery aneurysms in the presence of AAA has been reported to be as high as 20% to 40% in surveillance studies 1.

Key Considerations

• The size of the aneurysm is a critical factor in determining the treatment approach, with small aneurysms (less than 3 cm) usually monitored through regular imaging studies such as ultrasound or CT scans every 6-12 months.
• For larger aneurysms or those growing rapidly, surgical intervention is recommended, which may involve endovascular repair using stent grafts or open surgical repair 1.
• Preservation of at least 1 hypogastric artery is recommended, if anatomically feasible, to decrease the risk of pelvic ischemia 1.
• Risk factors include smoking, high blood pressure, atherosclerosis, and family history of aneurysms.

Management

• Patients diagnosed with iliac artery aneurysms should control blood pressure (target below 140/90 mmHg), quit smoking, maintain cholesterol levels within normal range, and take antiplatelet medications like aspirin (81-325 mg daily) as prescribed by their physician.
• Individualized treatment plans with shared decision-making are important when treating aorto-iliac aneurysm disease, considering the high risk of ischemic complications from exclusion of internal iliac arteries 1.

From the Research

Definition and Overview of Iliac Artery Aneurysm Dilation

• Iliac artery aneurysms are rare but associated with significant morbidity and mortality when ruptured 2.
• Isolated aneurysms of the iliac arteries are extremely rare, comprising less than 2% of all aneurysmal disease 3.
• These aneurysms are typically seen in older men and their natural history carries a significant risk of rupture when the aneurysms have attained a large size 3.

Symptoms and Diagnosis

• Iliac artery aneurysms can be asymptomatic or symptomatic, with symptoms including abdominal pain 4.
• Diagnostic workup includes preoperative imaging with computed tomography or magnetic resonance 3.
• The estimated mean diameter of isolated internal iliac artery aneurysms (IIIAAs) is 46.28 mm 5.

Treatment Options

• Treatment options for iliac artery aneurysms include open repair and endovascular repair 2, 3, 4, 5, 6.
• Endovascular repair is a feasible, safe, and effective treatment approach for large IIIAAs without adequate aneurysm necks 4.
• The combined approach of endovascular coil embolization and stent graft placement is associated with the lowest rates of endoleak and reintervention 4, 5.

Outcomes and Complications

• The overall estimated technical success rate for endovascular treatment of IIIAAs is 91.6% 5.
• The estimated overall 30-day mortality for endovascular repair is 2.8% 5.
• Buttock claudication is a common complication after hypogastric artery exclusion, occurring in 13.9% of patients 5.
• Endovascular repair of isolated IAAs appears safe and effective, with initial results similar to those after endovascular abdominal aortic aneurysm repair 6.