Open vs. endovascular repair of isolated iliac artery aneurysms: A 12-year experience
Presented at the Thirty-sixth Annual Symposium for the Society of Clinical Vascular Surgery, Las Vegas, Nevada, March 5-8, 2008.
Received 1 October 2008; accepted 26 November 2008. published online 23 February 2009.
Objective
To examine contemporary operative techniques and outcomes for repair of isolated iliac artery aneurysms.
Methods
We retrospectively reviewed the charts of all patients who underwent repair of an isolated iliac artery aneurysm from February 1995 to June 2007. Mycotic aneurysms and patients with concurrent infrarenal abdominal aortic aneurysms greater than 3.5 cm in diameter were excluded from analysis. Patients with prior abdominal aortic aneurysm repair were not excluded.
Results
Fifty-six patients (96% male; mean age, 72 ± 10 years) had either open (n = 24) or endovascular (n = 32) repair with median follow-up of 36 months. Seven patients were treated for rupture, six with open repair, and one with an endograft. Average aneurysm size for patients in the open and endovascular repair cohorts was 4.5 ± 2.4 cm and 4.0 ± 1.1 cm, respectively (P = .35). One episode of endograft limb thrombosis at five months was treated with catheter-directed thrombolytic therapy and stent placement. Thirty-day mortality for patients undergoing elective and emergent open repair was 1/18 (6%) and 1/6 (17%), respectively. There was no 30-day mortality for the endovascular group. Median length of stay was 10.5 days in the open group and one day in the endovascular elective group (P < .01). There was no mid-term aneurysm-related mortality in either group. Primary patency rates were similar between the open and endovascular groups at five years (100% vs. 96%, P = .07). Aneurysm sac diameter decreased in 67% (21/28) of patients that underwent endovascular repair. One patient with a Type III endoleak required relining of the endograft with a second endograft at 72 months.
Conclusion
These data demonstrate that in appropriately selected patients, endovascular repair of isolated iliac artery aneurysms is a safe, effective alternative to open repair with mid-term follow-up. Endovascular repair is associated with a significantly reduced hospital length of stay and may be associated with decreased need for transfusion and mortality when compared with open repair.
Division of Vascular Surgery, Department of Surgery, William Beaumont Hospital, Royal Oak, Mich
Reprint requests: Graham W. Long, MD, Surgical Clinical Trials Office, Department of Surgery, William Beaumont Hospital, 3601 West Thirteen Mile Rd, Royal Oak, MI 48073
Competition of interest: Dr. Long is a paid consultant to Cook, Inc, and Medtronic. Dr Brown is a paid speaker for W.L. Gore & Associates, Inc.
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