The aim of this review was to compare the outcomes of endovascular treatment (ET) versus open surgery (OS) for patients with isolated iliac artery aneurysms (IIAAs).
Methods:
Studies that reported ET and OS for IIAAs were searched in databases until December 5, 2018. Studies were included for reporting both ET and OS for patients with IIAAs, and at least one of the following outcomes: postoperative mortality, postoperative ischemic complications (PIC), wound complications, blood transfusion, and length of hospital stay (LHS). We adopted Inverse Variance method to calculate the mean difference (MD) of LHS, and adopted Mantel–Haenszel method for odds ratios (ORs) of postoperative mortality, PICs, wound complications, and blood transfusion.
Results:
Nine studies were included, and all of them were observational studies, 7 studies were available for meta-analysis. When compared with OS, ET was associated with a higher risk of PICs (OR: 3.24, 95% confidence interval [CI]: 1.05-10.02), a lower risk of blood transfusion (OR: 0.22, 95% CI: 0.08-0.58), and a much shorter LHS (MD: −4.39, 95% CI: −6.18 to −2.60). The postoperative mortality and wound complication were similar between groups.
Conclusion:
Both ET and OS were safe and effective methods to repair IIAAs with similar postoperative mortality. Compared with OS, ET can reduce the need for transfusion and the time of LHS, but it was associated with a higher risk of PICs. The comparisons of primary patency and reintervention rates were still unclear between the 2 groups.
RichardsonJWGreenfieldLJ. Natural history and management of iliac aneurysms. J Vasc Surg. 1988;8(2):165–171.
2.
HuangYGloviczkiPDuncanAA. Common iliac artery aneurysm: expansion rate and results of open surgical and endovascular repair. J Vasc Surg. 2008;47(6):1203–1210; discussion 1210-1201.
BacharachJMSlovutDP. State of the art: management of iliac artery aneurysmal disease. Catheter Cardiovasc Interv. 2008;71(5):708–714.
7.
UberoiRTsetisDShrivastavaVMorganRBelliAM. Subcommittee on reporting standards for arterial aneurysms of the society for vascular s. standard of practice for the interventional management of isolated iliac artery aneurysms. Cardiovasc Intervent Radiol. 2011;34(1):3–13.
8.
BuckDBBensleyRPDarlingJ. The effect of endovascular treatment on isolated iliac artery aneurysm treatment and mortality. J Vasc Surg. 2015;62(2):331–335.
9.
Bianchini MassoniCFreyrieAGargiuloM. Perioperative and late outcomes after endovascular treatment for isolated iliac artery aneurysms. Ann Vasc Surg. 2017;44:83–93.
10.
PatelNVLongGWCheemaZFRimarKBrownOWShanleyCJ. Open vs. endovascular repair of isolated iliac artery aneurysms: a 12-year experience. J Vasc Surg. 2009;49(5):1147–1153.
11.
MoherDLiberatiATetzlaffJAltmanDG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006–1012.
12.
HigginsJPAltmanDGGotzschePC. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.
13.
WellsGSheaBO’ConnellD. The Newcastle–Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Ottawa Hosp Res Inst. 2013;(3):1–4.
14.
PitouliasGADonasKPSchulteSHorschSPapadimitriouDK. Isolated iliac artery aneurysms: endovascular versus open elective repair. J Vasc Surg. 2007;46(4):648–654.
15.
ChaerRABarbatoJELinSCZenatiMKentKCMcKinseyJF. Isolated iliac artery aneurysms: a contemporary comparison of endovascular and open repair. J Vasc Surg. 2008;47(4):708–713.
16.
HalloulZWeberMUdelnowADudeckOMeyerF. [Increasingly individualised therapeutic options in the rare isolated aneurysm of the iliac artery—vascular surgical versus image-guided endovascular intervention]. Zentralbl Chir. 2013;138(5):554–562.
17.
IgariKKudoTToyofukuTJibikiMInoueY. Comparison between endovascular repair and open surgery for isolated iliac artery aneurysms. Surg Today. 2015;45(3):290–296. (1436-2813 (Electronic)).
18.
ZhorzelSBuschATrennerM. Open versus endovascular repair of isolated iliac artery aneurysms. Vasc Endovascular Surg. 2019;53(1):12–20. doi:10.1177/1538574418798418
19.
GabrielliRIraceLFelliMM. Classic and endovascular surgical management of isolated iliac artery aneurysms. Minerva Cardioangiol. 2007;55(2):133–148.
SahgalAVeithFJLipsitzE. Diameter changes in isolated iliac artery aneurysms 1 to 6 years after endovascular graft repair. J Vasc Surg. 2001;33(2):289–284; discussion 294-285.
25.
CaronnoRPiffarettiGTozziM. Endovascular treatment of isolated iliac artery aneurysms. Ann Vasc Surg. 2006;20(4):496–501.
26.
BosanquetDCWilcoxCWhitehurstL. Systematic review and meta-analysis of the effect of internal iliac artery exclusion for patients undergoing EVAR. Eur J Vasc Endovasc Surg. 2017;53(4):534–548.
27.
RaytHSBownMJLambertKV. Buttock claudication and erectile dysfunction after internal iliac artery embolization in patients prior to endovascular aortic aneurysm repair. Cardiovasc Intervent Radiol. 2008;31(4):728–734.
28.
MarconiMCeragioliSMocellinDM. Open surgical management of hypogastric artery during aortic surgery: ligate or not ligate?Ann Vasc Surg. 2015;29(4):780–785.
29.
ZhangTGuoWMaX. Novel-designed iliac branch stent graft for internal iliac artery reconstruction during aneurysm repair. Ann Vasc Surg. 2015;29(2):189–196.
30.
ShutzeRAOglesbyWLeeAShutzeWP. Results of repair of iliac artery aneurysms with the sandwich technique. Proc (Bayl Univ Med Cent). 2017;30(1):7–10.
31.
LobatoAC. Sandwich technique for aortoiliac aneurysms extending to the internal iliac artery or isolated common/internal iliac artery aneurysms: a new endovascular approach to preserve pelvic circulation. J Endovasc Ther. 2011;18(1):106–111.
32.
DuvnjakS.Endovascular treatment of aortoiliac aneurysms: from intentional occlusion of the internal iliac artery to branch iliac stent graft. World J Radiol. 2016;8(3):275–280.
33.
SiracuseJJSchermerhornMLMeltzerAJ. Comparison of outcomes after endovascular and open repair of abdominal aortic aneurysms in low-risk patients. Br J Surg. 2016;103(8):989–994.
34.
KakkosSKPapazoglouKOTsolakisIALampropoulosGPapadoulasSIAntoniadisPN. Open versus endovascular repair of inflammatory abdominal aortic aneurysms: a comparative study and meta-analysis of the literature. Vasc Endovascular Surg. 2015;49(5-6):110–118.
35.
ThomasDMHultenEAEllisST. Open versus endovascular repair of abdominal aortic aneurysm in the elective and emergent setting in a pooled population of 37,781 patients: a systematic review and meta-analysis. ISRN Cardiol. 2014;2014:149243.
36.
SwinnenJChaoATiwariACrozierJVicarettiMFletcherJ. Vertical or transverse incisions for access to the femoral artery: a randomized control study. Ann Vasc Surg. 2010;24(3):336–341.
37.
PejkicSDragasMIlicN. Incidence and relevance of groin incisional complications after aortobifemoral bypass grafting. Ann Vasc Surg. 2014;28(8):1832–1839.
38.
MatsumuraJSBrewsterDCMakarounMSNaftelDC. A multicenter controlled clinical trial of open versus endovascular treatment of abdominal aortic aneurysm. J Vasc Surg. 2003;37(2):262–271.
39.
BecqueminJPPilletJCLescalieF. A randomized controlled trial of endovascular aneurysm repair versus open surgery for abdominal aortic aneurysms in low- to moderate-risk patients. J Vasc Surg. 2011;53(5):1167–1173.e1161.
40.
PowellJTSweetingMJUlugP. Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years. Br J Surg. 2017;104(3):166–178.
41.
ChaikofELDalmanRLEskandariMK. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018;67(1):2–77. e72.
