Natural History of the Iliac Arteries after Endovascular Abdominal Aortic Aneurysm Repair and Suitability of Ectatic Iliac Arteries as a Distal Sealing Zone

Purpose: To investigate the natural history of dilated common iliac arteries (CIA) exposedto pulsatile blood flow after endovascular abdominal aortic aneurysm repair (EVAR) andthe suitability of ectatic iliac arteries as sealing zones using flared iliac limbs.Methods: Follow-up computed tomograms of 102 CIAs in 60 EVAR patients wereinvestigated. Diameter changes in CIAs #16 mm (group 1) were compared with changesin vessels where a dilated segment .16 mm in diameter continued to be exposed topulsatile blood flow (group 2). Within group 2, cases in which the stent terminatedproximal to the dilated artery segment (2a) were compared with those that had beentreated with a flared limb (2b).Results: The mean CIA diameter increased by 1.061.0 mm in group 1 (p,0.001 versusimmediately after EVAR) and by 1.561.7 mm in group 2 (p,0.001 versus immediately afterEVAR) within an average follow-up of 43.6618.0 months. Diameter increase was morepronounced in dilated CIAs (p50.048), and it was not significantly different betweengroups 2a and 2b (p50.188). No late distal type I endoleak or stent-graft migrationassociated with CIA ectasia was observed.Conclusion: Dilatation of the CIA is significant after EVAR, and it is more pronounced inectatic iliac arteries. Although ectatic iliac arteries appear to be suitable sealing zones in theshort term, continued follow-up is mandatory.J Endovasc Ther 2007;14:619–624Key words: endovascular aneurysm repair, common iliac artery, dilatation, ectatic artery,stent-graft, flared graft limb