Fate of Enlarged Iliac Arteries After Endovascular or Open Abdominal Aortic Aneurysm Repair

J Endovasc Ther. 2016 Oct;23(5):803-8. doi: 10.1177/1526602816661832. Epub 2016 Aug 2.


Purpose: To examine the fate of untreated ectatic and aneurysmal common iliac arteries (CIAs) after open treatment and endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA).

Methods: Databases of scientific literature were searched between January 1980 and February 2016 to identify publications on the follow-up of ectatic and aneurysmal CIAs after open or endovascular AAA repair. The primary outcome measure was the increase of iliac artery diameter during follow-up. The secondary outcome was the subsequent reintervention rate during follow-up.

Results: Only 3 open AAA and 3 EVAR studies containing 1239 patients met the inclusion criteria for analysis. In the open AAA group, ectatic iliac arteries (defined as 12-18 mm) had a diameter progression of 1.7 to 1.8 mm during a follow-up period of 51.6 to 85.2 months. The aneurysmal iliac arteries (>18 mm) in the open repair group showed a faster growth (2.3-3.0 mm) in a follow-up period of 50.4 to 85.2 months. The pooled assessment of arteries ≥18 mm had a mean growth of 2.56 mm at 60 months of follow-up. In the entire open AAA cohort, the reintervention rate for CIA transformation was <1%. In the EVAR studies, arbitrary cutoff sizes of 16 to 20 mm for ectatic arteries and >20 mm for aneurysmal arteries were used. During a follow-up of 39.2 to 60 months, the diameter progression was 1.5 mm for the 16-mm iliac arteries and 2.7 mm for the 20-mm iliac arteries. The need for endovascular reinterventions was similar in patients with previously normal or enlarged CIAs.

Conclusion: After open AAA repair, the overall size of CIA aneurysms grows slowly, but enlarged CIAs >20 mm in EVAR patients show faster growth during follow-up. However, the need for secondary interventions was similar in patients with normal or enlarged CIAs post EVAR.

Keywords: abdominal aortic aneurysm; common iliac artery; diameter; ectasia; endovascular aneurysm repair; iliac artery aneurysm; open repair; reintervention.

Publication types

  • Review

MeSH terms

  • Aortic Aneurysm, Abdominal / surgery*
  • Blood Vessel Prosthesis Implantation*
  • Endovascular Procedures
  • Follow-Up Studies
  • Humans
  • Iliac Aneurysm / pathology*
  • Iliac Artery
  • Time Factors
  • Treatment Outcome