title: Large iliac arteries: a high-risk group for endovascular aortic aneurysm repair.
abstract: OBJECTIVE
  To examine if the presence of large iliac arteries is a potential risk factor for the development of a type Ib endoleak (iliac sealing zone) or need for iliac artery-related secondary intervention in patients undergoing endovascular abdominal aortic aneurysm repair.
  
  
  METHODS
  The medical notes and all preoperative and postoperative plain abdominal radiographs and computer tomographic scans were reviewed for a consecutive series of 100 patients (89 men; mean age 75 years, range 56-91) with large iliac arteries (mean 19.7 mm, range 16-22) who had Zenith endovascular stent-grafts inserted for management of aortoiliac aneurysmal disease from January 1999 until September 2002. Endpoints were all-cause mortality, aneurysm-related death, endoleak, secondary intervention, secondary interventions, and stent-graft migration.
  
  
  RESULTS
  Mean follow-up was 30.1+/-8.3 months; at the last follow-up, 30% of patients were dead, 3% were aneurysm-related. Seven (7%) patients developed a type Ib endoleak, with the remainder being type II (29%), type Ia (2%), type III (1%), and type V (endotension, 1%). Eight (27.5%) type II endoleaks persisted, with the remainder closing spontaneously with sac shrinkage. The iliac artery-related secondary intervention rate was 10%, and the overall secondary intervention rate was 16%.
  
  
  CONCLUSIONS
  Iliac arteries between 16 and 22 mm in diameter may be treated with a cuff to the iliac limb with an expectation of 90% efficacy. Surveillance is required, with a high index of suspicion for type 1b endoleaks. Early secondary iliac intervention with extension to the external iliac artery is recommended if there is an increase in sac size after 6 months.
authors.affiliation: Department of Vascular Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. ciaranomcdonnell@gmail.com
authors.forename: Ciaran O
authors.initials: CO
authors.lastname: McDonnell
authors.forename: James B
authors.initials: JB
authors.lastname: Semmens
authors.forename: Yvonne B
authors.initials: YB
authors.lastname: Allen
authors.forename: Shirley J
authors.initials: SJ
authors.lastname: Jansen
authors.forename: D Mark
authors.initials: DM
authors.lastname: Brooks
authors.forename: Michael M D
authors.initials: MM
authors.lastname: Lawrence-Brown
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D004108:Dilatation, Pathologic; D005260:Female; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000209:etiology; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014904:Western Australia / Q000453:epidemiology