Natural history of common iliac arteries after aorto-aortic graft insertion during elective open abdominal aortic aneurysm repair.

Abstract Background This study aimed to determine the natural history of common iliac arteries (CIAs) after elective open infrarenal abdominal aortic aneurysm (AAA) repair with an aorto-aortic prosthetic graft. Methods All patients who had a straight tube graft inserted during elective AAA repair at our institution between 1995 and 2005 were prospectively followed up with pre- and post-operative computed tomography (CT) scans to monitor changes in CIA diameter and had their latest CT scan in 2007. Based on preoperative CIA diameter, patients were divided into group A (both CIAs normal, up to 12 mm in diameter), B (at least one ectatic CIA, 13 -18 mm) and C (at least one aneurysmal CIA, 19 - 25 mm). The mean follow-up was 7.1 years (range, 2.1 to 12.3). Results Among 201 patients eligible for the study, 92 (45.8%) were in group A, 63 (31.3%) in group B and 46 (22.9%) in group C. Overall, the diameter increased in 119 CIAs (29.6%) by a mean 1.1, 1.8 and 2.4 mm in groups A, B, and C, respectively; 14 CIAs (5.4%) progressed from “normal” to “ectatic”, and 9 (10.2%) from “ectatic” to “aneurysmal”. Three aneurysmal CIAs slightly exceeded the 25 mm threshold, but were no repaired. No patients showed a progression or development of occlusive iliac artery disease, or required repeat surgery due to excessive CIA enlargement. Conclusions This analysis showed that most CIAs do not expand after tube graft insertion during AAA repair and, when they do, the degree of dilation is minimal. Tube graft insertion during AAA repair is justified even for ectatic or moderately aneurysmal CIAs, and the procedure is safe and durable. The skepticism surrounding its selective use instead of a systematic bifurcated graft placement appears to be unwarranted.