Endovascular Management of Isolated Iliac Artery Aneurysms

Preoperative Planning and Imaging

The endovascular management of IAAs requires meticulous preoperative imaging and planning. In general, this consists of a computed tomography angiogram (CTA) with fine cuts (2 mm). Multiplanar three-dimensional reconstructions can be used to delineate complex anatomy ( Figure 1 ). This can be especially important in treating internal iliac artery aneurysms, which can have multiple outflow vessels that can require embolization. In addition, diagnostic angiography may be performed to obtain accurate measurements for graft sizing ( Figure 2 ). Angiograms done with calibrated catheters can be very useful in determining the correct length of the device, especially in tortuous vessels.

One of the first reported methods for the endovascular repair of IAAs was with a handmade graft of polytetrafluoroethylene (PTFE) sewn to a balloon-expandable stent. As the field of endovascular surgery has advanced, so have the grafts available to repair IAAs. Today, several stent grafts are available for endovascular repair of these aneurysms. These most often consist of a metal stent composed of nitinol or of stainless steel wrapped in a fabric coating—Dacron or PTFE. The devices come in various lengths and diameters, and tapering options are available as well. Tapered devices can even be backloaded onto the delivery system to allow a reverse taper. Each device is different in terms of its flexibility and size profiles. Dedicated iliac devices are not available because of the relatively low incidence of these aneurysms.