Endovascular Aneurysm Management in Iliac Arteries

Iliac artery aneurysms, whether isolated or coexisting with abdominal aortic aneurysms, pose a significant risk of rupture once the common iliac artery exceeds approximately 3 cm in diameter or when internal iliac branches are involved. Historically managed by open surgical repair, endovascular approaches have become first‐line owing to reduced perioperative morbidity and shorter hospital stays. Central to modern practice is the need to preserve pelvic perfusion and avoid complications such as buttock claudication and ischaemia. Techniques include standard endovascular aneurysm repair (EVAR) with limb extensions, coil embolisation of the internal iliac artery followed by external iliac sealing, bell‐bottom stent grafts for wide distal landing zones, and dedicated iliac branch devices that maintain flow into the hypogastric artery. Selection of strategy depends on aneurysm morphology, vessel diameter, tortuosity and the distance from renal arteries to the iliac bifurcation. Advances in device design—such as unibody bifurcated endografts combined with branch modules—and improvements in imaging guidance have expanded eligibility, allowing treatment in anatomically challenging cases. Mid- and long-term surveillance focuses on graft patency, sac shrinkage and freedom from endoleak, with reintervention reserved for significant leaks or limb occlusions. Global experience underscores the balance between technical success and preservation of quality of life through minimisation of pelvic ischaemic events.

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Endovascular Aneurysm Management in Iliac Arteries publication trend

The graph below shows the total number of articles in endovascular aneurysm management in iliac arteries across all publications each year (not limited to Nature Index journals).

Technical terms

Endovascular aneurysm repair (EVAR): A minimally invasive procedure in which a stent graft is deployed within the aneurysm to exclude it from circulation.

Iliac branch device (IBD): A specialised stent graft with a side branch designed to maintain perfusion of the internal (hypogastric) iliac artery.

Bell-bottom technique (BBT): An approach in which the distal limb of an aortic stent graft is flared to seal within a dilated common iliac artery.

Hypogastric artery (internal iliac artery): The vessel supplying pelvic organs and gluteal muscles, whose preservation reduces the risk of buttock claudication.

Endoleak: Persistent blood flow into the aneurysm sac outside the graft lumen, classified by source and requiring surveillance or intervention.

References

1. A Multicenter Assessment of Anatomic Suitability for Iliac Branched Devices in Eastern Asian Patients With Unilateral and Bilateral Aortoiliac Aneurysms. Frontiers in Cardiovascular Medicine (2022).
2. Successful endovascular repair of iliac artery aneurysms with unsuitable anatomy by combining unibody bifurcated endograft and iliac branch systems to preserve hypogastric artery blood flow: a report of two cases. Journal of Cardiothoracic Surgery (2022).
3. Navigating Challenges in the Endovascular Treatment of Asymptomatic Aortoiliac Aneurysms: A 10-Year Comparative Analysis. Journal of Clinical Medicine (2023).