Outcomes of open and endovascular repair for ruptured and nonruptured internal iliac artery aneurysms

Muhammad A. Rana, Manju Kalra, Gustavo Oderich, Eileen De Grandis, Peter Gloviczki, Audra A. Duncan, Steven S. Cha, Thomas C. Bower

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Objective To evaluate outcomes of open (OR) and endovascular repair (II-EVAR) of internal iliac artery aneurysms (IIAAs) with or without preservation of internal iliac artery (IIA) flow. Methods We reviewed the clinical data of consecutive patients treated for IIAAs between 2001 and 2012. End-points were morbidity, mortality, graft patency, and freedom from pelvic ischemic symptoms (buttock claudication, ischemic colitis, and spinal cord injury). Results There were 97 patients, 87 male and 10 female, with mean age of 74 ± 8 years. A total of 125 IIAAs (71 unilateral and 27 bilateral) with mean diameter of 3.6 ± 2 cm were treated. Eighty-two patients (86%) had elective repair and 15 (14%) required emergent repair (mean size, 6.7 ± 2.4 cm; range, 3.6-10 cm). OR in 60 patients (62%; 49 elective, 11 emergent) included IIA bypass in 36 (60%) patients and endoaneurysmorrhaphy in 24 (40%). II-EVAR in 37 patients (38%; 30 elective, 4 emergent) required IIA embolization in 29, iliac branch device in five or open IIA bypass in three, combined with bifurcated aortic stent grafts in 17. Early mortality was 1% for elective (1/49 open, 0/33 endovascular) and 7% for emergent repair (1/11 open, 0/4 endovascular). Early morbidity (43% vs 8%; P <.001) and length of stay (9 vs 1 day; P <.001) were significantly higher for OR as compared with II-EVAR. Pelvic ischemic complications occurred in 25 patients (26%), including hip claudication in 23, ischemic colitis in two, and paraplegia in one. Freedom from buttock claudication at 2 years was 25% in patients with no IIA preserved, 68% with preservation of one, and 95% with preservation of both IIAs (P =.002). Freedom from buttock claudication was higher after OR than after II-EVAR (79% vs 59%; P =.05). Primary and secondary patency rates of IIAA bypasses were 95%, and 80% at 1 and 3 years, respectively. Conclusions II-EVAR of IIAAs is associated with fewer complications and shorter hospital stay compared with OR. Open and endovascular IIA reconstructions have very good long-term patency, and preservation of IIA flow is associated with higher freedom from buttock claudication.

Original languageEnglish (US)
Pages (from-to)634-644
Number of pages11
JournalJournal of Vascular Surgery
Volume59
Issue number3
DOIs
StatePublished - Mar 1 2014

Fingerprint

Iliac Aneurysm
Iliac Artery
Buttocks
Ischemic Colitis
Length of Stay
Morbidity
Transplants
Mortality
Paraplegia
Spinal Cord Injuries
Stents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Outcomes of open and endovascular repair for ruptured and nonruptured internal iliac artery aneurysms. / Rana, Muhammad A.; Kalra, Manju; Oderich, Gustavo; De Grandis, Eileen; Gloviczki, Peter; Duncan, Audra A.; Cha, Steven S.; Bower, Thomas C.

In: Journal of Vascular Surgery, Vol. 59, No. 3, 01.03.2014, p. 634-644.

Research output: Contribution to journalArticle

Rana, MA, Kalra, M, Oderich, G, De Grandis, E, Gloviczki, P, Duncan, AA, Cha, SS & Bower, TC 2014, 'Outcomes of open and endovascular repair for ruptured and nonruptured internal iliac artery aneurysms', Journal of Vascular Surgery, vol. 59, no. 3, pp. 634-644. https://doi.org/10.1016/j.jvs.2013.09.060
Rana, Muhammad A. ; Kalra, Manju ; Oderich, Gustavo ; De Grandis, Eileen ; Gloviczki, Peter ; Duncan, Audra A. ; Cha, Steven S. ; Bower, Thomas C. / Outcomes of open and endovascular repair for ruptured and nonruptured internal iliac artery aneurysms. In: Journal of Vascular Surgery. 2014 ; Vol. 59, No. 3. pp. 634-644.
@article{6564acee36c745879dae86e648386892,
title = "Outcomes of open and endovascular repair for ruptured and nonruptured internal iliac artery aneurysms",
abstract = "Objective To evaluate outcomes of open (OR) and endovascular repair (II-EVAR) of internal iliac artery aneurysms (IIAAs) with or without preservation of internal iliac artery (IIA) flow. Methods We reviewed the clinical data of consecutive patients treated for IIAAs between 2001 and 2012. End-points were morbidity, mortality, graft patency, and freedom from pelvic ischemic symptoms (buttock claudication, ischemic colitis, and spinal cord injury). Results There were 97 patients, 87 male and 10 female, with mean age of 74 ± 8 years. A total of 125 IIAAs (71 unilateral and 27 bilateral) with mean diameter of 3.6 ± 2 cm were treated. Eighty-two patients (86{\%}) had elective repair and 15 (14{\%}) required emergent repair (mean size, 6.7 ± 2.4 cm; range, 3.6-10 cm). OR in 60 patients (62{\%}; 49 elective, 11 emergent) included IIA bypass in 36 (60{\%}) patients and endoaneurysmorrhaphy in 24 (40{\%}). II-EVAR in 37 patients (38{\%}; 30 elective, 4 emergent) required IIA embolization in 29, iliac branch device in five or open IIA bypass in three, combined with bifurcated aortic stent grafts in 17. Early mortality was 1{\%} for elective (1/49 open, 0/33 endovascular) and 7{\%} for emergent repair (1/11 open, 0/4 endovascular). Early morbidity (43{\%} vs 8{\%}; P <.001) and length of stay (9 vs 1 day; P <.001) were significantly higher for OR as compared with II-EVAR. Pelvic ischemic complications occurred in 25 patients (26{\%}), including hip claudication in 23, ischemic colitis in two, and paraplegia in one. Freedom from buttock claudication at 2 years was 25{\%} in patients with no IIA preserved, 68{\%} with preservation of one, and 95{\%} with preservation of both IIAs (P =.002). Freedom from buttock claudication was higher after OR than after II-EVAR (79{\%} vs 59{\%}; P =.05). Primary and secondary patency rates of IIAA bypasses were 95{\%}, and 80{\%} at 1 and 3 years, respectively. Conclusions II-EVAR of IIAAs is associated with fewer complications and shorter hospital stay compared with OR. Open and endovascular IIA reconstructions have very good long-term patency, and preservation of IIA flow is associated with higher freedom from buttock claudication.",
author = "Rana, {Muhammad A.} and Manju Kalra and Gustavo Oderich and {De Grandis}, Eileen and Peter Gloviczki and Duncan, {Audra A.} and Cha, {Steven S.} and Bower, {Thomas C.}",
year = "2014",
month = "3",
day = "1",
doi = "10.1016/j.jvs.2013.09.060",
language = "English (US)",
volume = "59",
pages = "634--644",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "3",

}

TY - JOUR

T1 - Outcomes of open and endovascular repair for ruptured and nonruptured internal iliac artery aneurysms

AU - Rana, Muhammad A.

AU - Kalra, Manju

AU - Oderich, Gustavo

AU - De Grandis, Eileen

AU - Gloviczki, Peter

AU - Duncan, Audra A.

AU - Cha, Steven S.

AU - Bower, Thomas C.

PY - 2014/3/1

Y1 - 2014/3/1

N2 - Objective To evaluate outcomes of open (OR) and endovascular repair (II-EVAR) of internal iliac artery aneurysms (IIAAs) with or without preservation of internal iliac artery (IIA) flow. Methods We reviewed the clinical data of consecutive patients treated for IIAAs between 2001 and 2012. End-points were morbidity, mortality, graft patency, and freedom from pelvic ischemic symptoms (buttock claudication, ischemic colitis, and spinal cord injury). Results There were 97 patients, 87 male and 10 female, with mean age of 74 ± 8 years. A total of 125 IIAAs (71 unilateral and 27 bilateral) with mean diameter of 3.6 ± 2 cm were treated. Eighty-two patients (86%) had elective repair and 15 (14%) required emergent repair (mean size, 6.7 ± 2.4 cm; range, 3.6-10 cm). OR in 60 patients (62%; 49 elective, 11 emergent) included IIA bypass in 36 (60%) patients and endoaneurysmorrhaphy in 24 (40%). II-EVAR in 37 patients (38%; 30 elective, 4 emergent) required IIA embolization in 29, iliac branch device in five or open IIA bypass in three, combined with bifurcated aortic stent grafts in 17. Early mortality was 1% for elective (1/49 open, 0/33 endovascular) and 7% for emergent repair (1/11 open, 0/4 endovascular). Early morbidity (43% vs 8%; P <.001) and length of stay (9 vs 1 day; P <.001) were significantly higher for OR as compared with II-EVAR. Pelvic ischemic complications occurred in 25 patients (26%), including hip claudication in 23, ischemic colitis in two, and paraplegia in one. Freedom from buttock claudication at 2 years was 25% in patients with no IIA preserved, 68% with preservation of one, and 95% with preservation of both IIAs (P =.002). Freedom from buttock claudication was higher after OR than after II-EVAR (79% vs 59%; P =.05). Primary and secondary patency rates of IIAA bypasses were 95%, and 80% at 1 and 3 years, respectively. Conclusions II-EVAR of IIAAs is associated with fewer complications and shorter hospital stay compared with OR. Open and endovascular IIA reconstructions have very good long-term patency, and preservation of IIA flow is associated with higher freedom from buttock claudication.

AB - Objective To evaluate outcomes of open (OR) and endovascular repair (II-EVAR) of internal iliac artery aneurysms (IIAAs) with or without preservation of internal iliac artery (IIA) flow. Methods We reviewed the clinical data of consecutive patients treated for IIAAs between 2001 and 2012. End-points were morbidity, mortality, graft patency, and freedom from pelvic ischemic symptoms (buttock claudication, ischemic colitis, and spinal cord injury). Results There were 97 patients, 87 male and 10 female, with mean age of 74 ± 8 years. A total of 125 IIAAs (71 unilateral and 27 bilateral) with mean diameter of 3.6 ± 2 cm were treated. Eighty-two patients (86%) had elective repair and 15 (14%) required emergent repair (mean size, 6.7 ± 2.4 cm; range, 3.6-10 cm). OR in 60 patients (62%; 49 elective, 11 emergent) included IIA bypass in 36 (60%) patients and endoaneurysmorrhaphy in 24 (40%). II-EVAR in 37 patients (38%; 30 elective, 4 emergent) required IIA embolization in 29, iliac branch device in five or open IIA bypass in three, combined with bifurcated aortic stent grafts in 17. Early mortality was 1% for elective (1/49 open, 0/33 endovascular) and 7% for emergent repair (1/11 open, 0/4 endovascular). Early morbidity (43% vs 8%; P <.001) and length of stay (9 vs 1 day; P <.001) were significantly higher for OR as compared with II-EVAR. Pelvic ischemic complications occurred in 25 patients (26%), including hip claudication in 23, ischemic colitis in two, and paraplegia in one. Freedom from buttock claudication at 2 years was 25% in patients with no IIA preserved, 68% with preservation of one, and 95% with preservation of both IIAs (P =.002). Freedom from buttock claudication was higher after OR than after II-EVAR (79% vs 59%; P =.05). Primary and secondary patency rates of IIAA bypasses were 95%, and 80% at 1 and 3 years, respectively. Conclusions II-EVAR of IIAAs is associated with fewer complications and shorter hospital stay compared with OR. Open and endovascular IIA reconstructions have very good long-term patency, and preservation of IIA flow is associated with higher freedom from buttock claudication.

UR - http://www.scopus.com/inward/record.url?scp=84894561092&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84894561092&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2013.09.060

DO - 10.1016/j.jvs.2013.09.060

M3 - Article

C2 - 24571938

AN - SCOPUS:84894561092

VL - 59

SP - 634

EP - 644

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 3

ER -