Chapter 75 - isolated iliac aneurysms

Question 1

Mott 1827 and Halstead 1912 on iliac aneurysm

Answer 1

First descriptions

Question 2

Prevalence of isolated iliac aneurysm

Answer 2

< 2%

Question 3

Iliac segment contribution to aneurysm

Answer 3

CIA 70-90%
internal 10-30%

Bilateral IAA 50%

Question 4

Risk factors for iliac aneurysms

Answer 4

1) HTN
2) smk
3) trauma
4) iatrogenic
5) arteritis
6) connective tissue disease
7) infection

Question 5

Causes of infection in aneurysms

Answer 5

Historic: syphilis, TB
Now: Samonella, Staph, Klebsiella, Candida

Question 6

Tilson theory on EIA resiliance

Answer 6

Distinct embryonic lineage

Question 7

Growth rate of iliac aneurysm

Answer 7

< 3cm: 0.05-0.15 cm/yr

> 3cm: 0.26-0.29 cm/yr

Question 8

If concomitant AAA; how does it affect CIA aneurysm growth

Answer 8

it does not

Question 9

Ruptured IAA key points

Answer 9

1) 33% found at diagnosis
2) 28% mortality vs 5% in elective
3) mean size 6-6.8cm

Question 10

EIA ruptures?

Answer 10

Single series of 11 cases by Kato

all > 4cm

Question 11

IIA ruptures

Answer 11

1) 40% at presentation
2) 31% mortality
3) 7.7 cm mean size

Question 12

Isolated IIAA rate

Answer 12

30% of all iliac aneurysms

Question 13

Threshold for repair of iliac aneurysms

Answer 13

3-3.5 cm for elective repair

< 4cm not likely to rupture

Question 14

Symptoms caused by iliac aneurysms

Answer 14

1) mass effect
2) emboli
3) rupture

Question 15

Hammond + Horn 1958

Answer 15

First identified association of AAA with smoking

Question 16

Risks for AAA growth and rupture

Answer 16

Growth: smk, non-DM
Rupture: smk, age, BP

Question 17

Primary patency with open repair of iliac aneurysm

Answer 17

100% at 5 years

Question 18

OSR complication rate and types of complication for iliac aneurysms

Answer 18

22%

1) LE ischemia
2) visceral/pelvic ischemia
3) aneurysm reperfusion and rupture
4) AEF
5) infection
6) ureteral, neural, venous injuries

Question 19

When did endo Tx for iliac aneurysms surpass open

Answer 19

2003

Question 20

Rate of late aneurysmal degeneration in iliac following EVAR

Answer 20

2.4% at 9 years

Question 21

Bell bottom iliac limbs can dilate in this rate

Answer 21

35.3%

Endoleak 17.6%
Reoperate 15.7%

Question 22

Average increase in aneurysm dilation following treatment

Answer 22

year 1: 16%
year 2: 29%
year 3: 57%
year 4: 95%

Question 23

Covering internal with or without emboli key points

Answer 23

no difference in mortality, reintervention or claudication

Question 24

What provides the most collateral to ipsilateral internal iliac embolization

Answer 24

EIA and CFA provide more than contralateral IIA

Question 25

Yano classification

Answer 25

Class 0: no symptoms Class 1: non-limiting claudication with exercise Class 2: new impotence +/- butt pain that limits exercise Class 3: butt rest pain, ischemic colitis

Question 26

Risk for pelvic claudication

Answer 26

1) stenosis of contralateral IIA > 70% with > 3/6 branch nonopacify 2) small/diseased medial and lateral circumflex ipsilateral side

Question 27

IBE patency

Answer 27

90% at 2 years

Question 28

IBD patency

Answer 28

87% at 5 years

Question 29

Melas classification for isolated iliac artery aneurysms

Answer 29

Type A: CIA to CIA Type B1: CIA to IIA with 2cm IIA landing Type B2: CIA to IIA without 2cm IIA landing Type C: Ao to CIA Type D1: Ao to IIA with 2cm IIA landing Type D2: Ao to IIA without 2cm IIA landing Type E: CIAA after previous open or endo AAA repair