Open vs. Endovascular Repair of Isolated Iliac Artery Aneurysms: A Twelve-Year Experience

OBJECTIVES: To examine contemporary operative techniques and outcomes of 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 1995 to 2007.
RESULTS: Fifty-nine patients (93% male; mean age 72 +/- 10 years) had either open (n=27) or endovascular (n=32) repair with mean follow-up of 30.8 +/- 23.6 and 58.3 +/- 44.0 months, respectively. Average aneurysm size for patients in the open and endovascular repair cohorts was 5.0 +/- 2.5cm and 4.1 +/- 1.5cm, respectively (p=0.82). Nine patients were treated for rupture, eight with an open repair and one with an endograft. There were no 30-day mortalities in either group undergoing elective repair. Mortality for patients undergoing emergent open repair was 11% (n=3) and 0% for those with emergent stent graft repair (p<0.0001). There were seven significant complications in six patients, all in the emergent, open repair group. In the endograft group, there was a single Type 1 endoleak, repaired with stent graft extension, and one persistent Type 2 endoleak. One episode of endograft limb thrombosis occurred and was treated with catheter-directed thrombolytic therapy and balloon angioplasty. Average length of stay was 8.9 +/-4.9 days in the open elective group and 3.3 +/-6.4 days in the endovascular elective group (p=0.0029). There was no mid-term aneurysm-related mortality in any group.
CONCLUSIONS: These data demonstrate that endovascular repair of isolated iliac artery aneurysms is a safe, effective alternative to open repair with mid-term follow-up. It is associated with a significantly reduced length of stay compared with open repair in the elective setting.