Isolated Internal Iliac artery aneurysms are rare and asymptomatic condition that most of them are diagnosed incidentally. Due to the nonspecific symptoms of IIAAs, their deep anatomical location, and the probability of rupture, they can be fatal. Open surgery is the traditional treatment for IAAs, but open surgery can be technically challenging and Endovascular treatment of aneurysmal arteries may be a useful alternative to open surgery, as it can reduce post-operative mortality and morbidity.

A 63 years old heavy smoker male presented with an accidentally findings in imaging, such as iliac aneurysm in abdominopelvic U٫S with no symptoms. CTА, showed bilateral CIA aneurysms (L:29 mm, R: 38 mm) and right side internal iliac artery aneurysm (8 cm) with healthy aorta. Due to absence of proper proximal landing zone for aneurysm in common iliac arteries, we decided to coil embolization of internal iliac with EVAR to treat patient. The procedure performed successfully with no Endo leak in completion angiography. Patient discharged 2 days after procedure with no complication. This case was reported in line with the SCARE criteria.

EVAR techniques usually involve stent graft placement, embolization, or revascularization of the IIA, which may include IIA stent graft implantation, the sandwich technique, and iliac branch devices (IBDs), and the IIA is preserved whenever possible. Because of unilateral coverage of internal iliac and minimal risk of pelvic ischemia, IBD was not required. We treated our case via coil embolization of internal iliac with EVAR.

Elective treatment of isolated Internal Iliac artery aneurysms (IIAAs) with EVAR has been shown to be safe and effective.

This case report presents the rare occurrence of hematochezia due to an internal iliac artery aneurysm leading to an arterioenteric fistula, expanding the differential diagnosis for gastrointestinal bleeding. It emphasizes the importance of considering vascular origins in cases of atypical hematochezia, particularly in the absence of common gastrointestinal causes, and highlights the role of imaging and multidisciplinary management in diagnosing and treating such unusual presentations.

A 75-year-old man with a history of hypertension presented with 12 d of hematochezia, experiencing bloody stools 7-8 times per day. Initial computed tomography (CT) scans revealed an aneurysmal rupture near the right internal iliac artery with suspected hematoma development. Hemoglobin levels progressively decreased to 7 g/dL. Emergency arterial angiography and iliac artery-covered stent placement were performed, followed by balloon angioplasty. Despite initial stabilization, minor rectal bleeding and abdominal pain persisted, leading to further diagnostic colonoscopy. This identified a neoplasm and potential perforation at the proximal rectum. An exploratory laparotomy confirmed the presence of a hematoma and an aneurysm invading the rectal wall, necessitating partial rectal resection, intestinal anastomosis, and ileostomy. Postoperative recovery was successful, with no further bleeding incidents and normal follow-up CT and colonoscopy results after six months.

In cases of unusual gastrointestinal bleeding, it is necessary to consider vascular causes for effective diagnosis and intervention.

Background/Objectives: Aneurysms and dissections of the iliac artery (ADIAs) are significant vascular conditions often associated with aortic pathologies. Despite their importance, reports on isolated iliac artery pathologies are rare. This study aimed to investigate the epidemiology of ADIA in Switzerland including treatment incidence and hospital outcomes. Methods: A retrospective analysis of diagnosis-related group (DRG) statistics from 2011 to 2018 in Switzerland was conducted, identifying all cases of ADIA while excluding those with concomitant treatment of aortic pathologies. Age-standardized incidence rates and treatment outcomes were assessed, with multivariable logistic regression performed to identify factors associated with hospital mortality. Results: From 2011 to 2018, 1037 ADIA cases were hospitalized in Switzerland. Incidence rates for elective treatment were significantly higher in men than women, increasing in men from 1.5 to 2.4 cases per 100,000 men (p = 0.007), while remaining stable in women at around 0.2 cases per 100,000 women. Acute treatment incidence rates were lower but still higher in men, at 0.9 cases per 100,000 men and 0.2 cases per 100,000 women. Crude hospital mortality rates were lower for endovascular repair than open surgical repair in both elective (0.8% vs. 3.1%, p = 0.023) and emergency treatment (6.7% vs. 18.4%, p = 0.045). Multivariable analysis showed that endovascular repair was associated with significantly reduced hospital mortality compared to open repair (OR 0.27, 95%-CI: 0.10 to 0.66, p = 0.006). Conclusions: This nationwide study of iliac artery pathologies shows that the treatment incidence was about 10 times higher in men than in women for elective procedures, but only about five times higher for emergency treatment. Endovascular procedures were associated with significantly lower hospital mortality than open procedures, while hospital mortality rates were comparable for men and women.

The European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with aneurysms of the abdominal aorta and iliac arteries in succession to the 2011 and 2019 versions, with the aim of assisting physicians and patients in selecting the best management strategy.

The guideline is based on scientific evidence completed with expert opinion on the matter. By summarising and evaluating the best available evidence, recommendations for the evaluation and treatment of patients have been formulated. The recommendations are graded according to a modified European Society of Cardiology grading system, where the strength (class) of each recommendation is graded from I to III and the letters A to C mark the level of evidence.

A total of 160 recommendations have been issued on the following topics: Service standards, including surgical volume and training; Epidemiology, diagnosis, and screening; Management of patients with small abdominal aortic aneurysm (AAA), including surveillance, cardiovascular risk reduction, and indication for repair; Elective AAA repair, including operative risk assessment, open and endovascular repair, and early complications; Ruptured and symptomatic AAA, including peri-operative management, such as permissive hypotension and use of aortic occlusion balloon, open and endovascular repair, and early complications, such as abdominal compartment syndrome and colonic ischaemia; Long term outcome and follow up after AAA repair, including graft infection, endoleaks and follow up routines; Management of complex AAA, including open and endovascular repair; Management of iliac artery aneurysm, including indication for repair and open and endovascular repair; and Miscellaneous aortic problems, including mycotic, inflammatory, and saccular aortic aneurysm. In addition, Shared decision making is being addressed, with supporting information for patients, and Unresolved issues are discussed.

The ESVS Clinical Practice Guidelines provide the most comprehensive, up to date, and unbiased advice to clinicians and patients on the management of abdominal aorto-iliac artery aneurysms.

To demonstrate successful treatment of a patient with aneurysmal lesions of several aortic segments.

A patient with myelodysplastic syndrome and pancytopenia underwent endovascular repair for abdominal aortic aneurysm. Aneurysm of common iliac artery and borderline thoracic aortic aneurysm occurred 2 years after surgery. For this reason, the patient underwent repeated surgery with implantation of a modified iliac bifurcation component with favorable immediate result. The patient was discharged with recommendations for further follow-up. However, repeated CT aortography after a year revealed type 1A endoleak and enlargement of thoracic aortic aneurysm. Considering aortic anatomy and comorbidities, the aortic team preferred endovascular multilevel aortic reconstruction.

Stenting for exclusion of type 1A endoleak was impossible. Thus, the patient underwent endovascular thoracoabdominal aortic repair with T-branch device while maintaining blood flow through visceral arteries. The stent graft previously implanted in abdominal position was connected to the T-branch using a physician-modified PTFE stent graft. To seal the system, additional iliac components were simultaneously implanted into the modified stent graft. The last ones were distally landed in iliac stent grafts installed after primary surgery. Stenting of descending aorta was additionally performed.

Complex intervention allowed reconstruction of the entire aorta in a patient with hematopoietic abnormalities. Currently, such treatment tactics can be used as an alternative to total open surgical approach in comorbid patients.

Segmental arterial mediolysis is a noninflammatory nonatherosclerotic vasculopathy of uncertain etiology characterized by dissection and/or aneurysm formation. It affects medium-to-large arteries, primarily the celiac, superior mesenteric, and renal arteries. Iliac involvement is rare, and its specific treatment has not been described. We detail a patient who presented with intrabdominal hemorrhage from a ruptured right colic artery aneurysm. He underwent transcatheter arterial embolization followed by right hemicolectomy. Histopathology confirmed the diagnosis of segmental arterial mediolysis. Endovascular treatment of a 3-cm iliac artery aneurysm was performed 18 months later. There was successful exclusion of the aneurysm demonstrated on computed tomography angiography at 10 years.

While the Society for Vascular Surgery recommends repair of abdominal aortic aneurysms (AAA) at ≥5.5 cm in men and ≥5.0 cm in women, AAA repair below these thresholds has been well documented. There are clear indications for repair other than these strict size criteria, but the expected proportion of such repairs in one's practice has not been studied. We sought to characterize the indications for repairs of aneurysms below diameter recommendations at a single academic center. Using the assumption that this real-world experience would approximate that of other practices, we then used national data to extrapolate these findings.

A single-center retrospective review was conducted of all elective open (oAAA) and endovascular (EVAR) AAA repairs (2010-20) to assess the incidence of and indications for repair of aneurysms below diameter recommendations (defined as <5.5cm in men and <5.0cm in women). Reasons for these repairs were defined as: 1) iliac aneurysm, 2) saccular morphology, 3) rapid expansion, 4) patient anxiety, 5) distal embolization, 6) other, and 7) no documented reason. The Vascular Quality Initiative (VQI) was queried for all asymptomatic oAAA and EVAR (2010-20) and repairs below diameter recommendations were identified. Findings from the single-center analysis were applied to the VQI cohort to extrapolate estimates of reasons for repairs done nationally. In-hospital mortality and major adverse cardiac events (MACE) were compared between those below size recommendations and those meeting size recommendations.

Of 456 elective AAA repairs at our center, 147 (32%) were below size recommendations. This was more common for EVAR (35% vs 28%). Reasons were: not documented (41%), iliac aneurysm (23%), saccular (10%), rapid expansion (10%), patient anxiety (7%), other (6%), and distal embolism (3%). Of 44,820 elective AAA repairs in VQI, 17,057 (38%) were below size recommendations (40% EVAR, 26% oAAA). Patients who were repaired below size recommendations had lower in-hospital death (oAAA: 2.4% vs 4.6% p<0.0001; EVAR: 0.3% vs 0.8% p<0.0001). When single-center findings were applied to the VQI dataset, an estimated 10,064 repairs were performed nationally for acceptable indications other than size criteria. Conversely, there may have been 6993 repairs (with an associated 35 deaths) performed without documented indication.

Repairs for AAA below recommended diameter guidelines account for approximately one third of all elective AAA procedures in both VQI and our single-center experience. Assuming our practice is typical, nearly 60% of repairs below size recommendations meet criteria for other clear reasons. The remaining 40% lack a documented reason, meaning 13% of all elective AAA repairs were done for aneurysms below size recommendations without an acceptable indication. As awareness of overuse/underuse is heightened, these data help estimate the expected proportion of repairs for less common pathologies. They also provide a potential baseline data point for efforts at reducing overuse.

Isolated iliac artery aneurysms are less frequent than abdominal aortic aneurysms, with the same, predominantly atherosclerotic-degenerative etiology, but patients present more frequently with symptoms or at the stage of rupture. The majority of those affected are men over the age of 65. The ideal imaging technique for diagnosis, treatment planning and follow-up is computed tomography (CT) angiography. Below a diameter of 4 cm, the risk of rupture is 6.3%, and then increases significantly with increasing diameter. Today, treatment is recommended from a size of 3.5 cm at the earliest.

Because of the lower mortality, endovascular therapy is the leading treatment for the elective and emergency situation. The quality of the landing zones, which are important for sealing, is decisive for elimination of the aneurysm. The elimination is carried out by means of stent grafts, often in combination with embolization. Due to the risk of buttock claudication and erectile dysfunction, the preservation of ipsilateral pelvic perfusion is recommended in cases of insufficient collateralization. Special iliac branch devices or various parallel endograft techniques are available for this purpose.

The main problem of endovascular treatment are endoleaks and the associated need for reintervention. Imaging control by means of CT angiography is crucial for timely endoleak detection, especially in the early phase.