Endovascular Treatment for Patients With Isolated Internal Iliac Artery Aneurysm: A Single-Center Retrospective Study Over a 10-Year Period

Abstract

Objectives:

Isolated internal iliac artery aneurysm (IIIAA) is a rare condition, accounting for approximately 0.3% to 0.5% of all intra-abdominal aneurysms. This study aimed to evaluate the outcomes of endovascular treatment for IIIAA using a relatively large cohort.

Methods:

A retrospective analysis was conducted on 45 patients diagnosed with IIIAA who were admitted to our hospital between April 2014 and April 2024. Patient demographics, intervention outcomes, and follow-up results were collected and analyzed.

Results:

A total of 45 patients (only 2 female) with 49 IIIAAs were included, with a mean age of 70.4±9.2 years. The cohort exhibited a high prevalence of cardiovascular and cerebrovascular risk factors, and 31.1% had a history of malignancy. Thirty patients (66.7%) were diagnosed with an incidental IIIAA, while the remaining patients presented with symptoms such as abdominal or lumbar pain, dysuria, or aneurysm rupture. Stent-graft placement alone was performed in 3 patients, coil embolization alone in 5 patients, and the remaining 37 patients underwent a combined approach. The rate of complete distal branch embolization was 69.0% (29/42), and technical success was achieved in 44 patients. The mean follow-up duration was 23.8±21.5 months. During follow-up, 5 patients died from cancer or heart failure. Buttock claudication was observed in 7 patients, with only 1 case remaining unresolved after conservative treatment. Sac dilation was noted in 4 patients who had incomplete distal branch embolization; of these, 3 required re-intervention. The 12-month and 24-month re-intervention-free survival rates were 95.5% and 88.2%, respectively.

Conclusion:

Endovascular treatment, particularly the combination of stent-graft implantation and coil embolization, is both safe and effective for IIIAA, with a mid-term re-intervention-free survival rate of 85.25% and an acceptable risk of pelvic ischemia. Complete embolization of the outflow branches is technically challenging in some cases, and the efficacy of sac embolization as an alternative remains debatable.

Clinical Impact

Isolated internal iliac artery aneurysm (IIIAA) is an exceedingly rare condition. This retrospective study identified and included 45 patients with IIIAA who were treated at our institution to evaluate the safety and therapeutic efficacy of endovascular treatment. The majority of patients underwent stent-graft implantation to seal the internal iliac artery ostium, along with coil embolization of the distal branches. The 2-year reintervention-free survival rate for all patients was 85.25%, demonstrating the favorable efficacy of endovascular treatment. However, postoperative sac dilation was observed in 4 patients who did not receive complete distal branch embolization, emphasizing the need for rigorous follow-up in this subset of patients.

Keywords

isolated internal iliac artery aneurysm endovascular treatment coil embolization

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