Isolated iliac artery aneurysms: A contemporary comparison of endovascular and open repair
Presented at the Eastern Vascular Society Annual Meeting, Washington, DC, Sep 28-30, 2006.
Received 4 June 2007; accepted 8 November 2007.
Objective
Iliac artery aneurysms are rare but associated with significant morbidity and mortality when ruptured. This study compares recent open and endovascular repairs of iliac aneurysms at a single institution.
Methods
Patients were identified and charts reviewed using ICD-9 and CPT codes for iliac artery aneurysm and open or endovascular repair performed between January 2000 and January 2006. Baseline characteristics, procedure-related variables, and follow-up data were retrospectively reviewed.
Results
A total of 71 patients were treated with isolated iliac artery aneurysms. There were 19 open and 52 endovascular repairs. Seven presented with acute ruptures and were treated by open (4) or endovascular (3) repair. Preoperative comorbidities were similar between the two groups. Major perioperative (30 day) complications included three deaths in the open group from cardiovascular complications, all after ruptured aneurysm repair, and one death in the endovascular group (after rupture; one additional perioperative death occurred after 30 days due to colonic infarction) (P = NS). Postoperative complications were less frequent in the endovascular group, although this did not reach statistical significance. The mortality was 50% in the open group and 33% in the endovascular group for patients presenting with a ruptured aneurysm (P = NS). Transfusion requirement was significantly higher in the open group (47%) than in the endovascular group (6%) (P = .03). The mean follow-up was 20 ± 5 months in the open group and 17 ± 2 months in the endovascular group (P = NS). Long-term complications included two limb thromboses following repair with a bifurcated stent graft that were treated with thrombolysis plus stenting or a fem-fem bypass. Three endoleaks were identified on postop CT scans, all of which were successfully managed with endovascular techniques. There were no postoperative ruptures or aneurysm-related death. The mean postoperative length of stay was 5.2 ± 2.3 days (open) and 1.3 ± 1.0 days (endovascular) (P = .04).
Conclusions
This is the first large, case control study comparing open vs endovascular repair of isolated iliac artery aneurysms. Endovascular repair of iliac artery aneurysms is safe and results in decreased length of stay, lower requirement for perioperative blood transfusion, and similar intermediate term outcomes as open repair.
aColumbia/Weill Cornell Division of Vascular Surgery, New York Presbyterian Hospital, New York, NY
bUniversity of Pittsburgh, Presbyterian Hospital, Pittsburgh, Pa.
Reprint requests: James F McKinsey, MD, Site Chief, Division of Vascular Surgery, Associate Professor of Clinical Surgery, Columbia University College of Physicians and Surgeons New York-Presbyterian Hospital/Columbia, Irving Pavilion Room 648, 161 Fort Washington Avenue, New York, NY 10032.
Competition of interest: none.
Additional material for this article may be found online at www.jvascsurg.org.
ABSTRACT