[Increasingly individualised therapeutic options in the rare isolated aneurysm of the iliac artery--vascular surgical versus image-guided endovascular intervention].

BACKGROUND

Isolated aneurysms of the iliac artery are rare but in case of rupture potentially life-threatening.

AIM, PATIENTS AND METHODS: The aim of this systematic, clinical, prospective observational study was to retrospectively evaluate prospectively collected perioperative data obtained in consecutive patients with an isolated iliac artery aneurysm with regard to the diagnostic and therapeutic management including the outcome characterised by periinterventional morbidity, lethality, and overall survival over an intermediate time course of the follow-up.

RESULTS

From 01/01/2002 to 03/31/2013, overall 35 patients with an isolated iliac artery aneurysm were diagnosed (females, n = 3 [8.6 %]; mean age, 70 [46-83] years). The mean hospital stay was 13 days. There were 24 aneurysms at the common iliac artery (AIC; 69 %), 8 at the internal iliac artery (AII; 23 %) and 3 at the external iliac artery (AIE; 9 %). Three patients (9 %) with an aneurysmatic rupture were admitted. The therapeutic options comprised: 12 patients underwent open resection and subsequent implantation of a prosthesis (34 %), 17 individuals were treated with an endovascular repair (49 %); 5 cases were managed with a "wait and see" policy (14 %). There was no lethality among the elective interventions whereas the lethality of emergency cases was 33 % (n = 1). Subdividing the patients treated with open surgery versus endovascular repair indicates significant differences of the preoperative characteristics, e.g., of the proportions of AIC in the distribution of aneurysmatic sites (75 % vs. 59 %; p = 0.007) reflecting the differential indication.

CONCLUSIONS

Isolated iliac artery aneurysms can be approached with open surgery or with an endovascular repair depending on elective or emergency circumstances. In addition, clinical status of the patient and personal experience need to be taken into account. Depending on aneurysmatic site, extension, combination with accompanying findings and implantation sites at the proximal and distal sites of the aneurysm, the less invasive and less traumatic image-guided radiological approach can provide acceptable therapeutic success with regard to the sufficient exclusion of the aneurysm and can be increasingly used according to the individual patient and his/her findings.