Treatment of Iliac Artery Aneurysm: When to Repair and How to Choose the Surgical Approach

Clinical Scenario

Iliac artery aneurysm may involve the common iliac artery, the internal iliac artery, the external iliac artery, or a combination of these vessels. The central management question is whether the aneurysm has reached a size at which elective intervention is warranted, and — when it has — which repair strategy best fits the individual patient's anatomy and clinical profile.

Treatment Approach

Elective repair is considered once the aneurysm reaches a defined diameter threshold. When repair is undertaken, it can be carried out via open surgical or endovascular means, with the preferred approach determined by individual patient and lesion characteristics. Preservation of arterial supply to the pelvis is a key consideration in the planning of any repair strategy.

The complete structured regimen — including the specific threshold criteria, technique selection factors, and the full vessel-preservation algorithm — is available in the protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.ejvs.2023.11.002

Patients with an iliac artery aneurysm (common iliac artery, internal iliac artery, and external iliac artery, or combination thereof) should be considered for elective repair at a diameter of ≥40 mm.
The choice of surgical technique for iliac artery aneurysm repair should be considered based on individual patient and lesion characteristics.
Preserving blood flow to at least one internal iliac artery during open surgical and endovascular repair of iliac artery aneurysms is recommended.
For patients undergoing common iliac artery aneurysm repair in whom internal iliac artery embolisation or ligation is necessary, occlusion of the proximal main stem of the vessel is recommended if technically feasible, to preserve the distal collateral circulation to the pelvis.

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