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. 2015 Aug;62(2):331-5.
doi: 10.1016/j.jvs.2015.03.027. Epub 2015 May 2.

The effect of endovascular treatment on isolated iliac artery aneurysm treatment and mortality

Dominique B Buck  1 , Rodney P Bensley  2 , Jeremy Darling  2 , Thomas Curran  2 , John C McCallum  2 , Frans L Moll  3 , Joost A van Herwaarden  3 , Marc L Schermerhorn  4
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The effect of endovascular treatment on isolated iliac artery aneurysm treatment and mortality

Dominique B Buck et al. J Vasc Surg. 2015 Aug.

Abstract

Objective: Isolated iliac artery aneurysms are rare, but potentially fatal. The effect of recent trends in the use of endovascular iliac aneurysm repair (EVIR) on isolated iliac artery aneurysm-associated mortality is unknown.

Methods: We identified all patients with a primary diagnosis of iliac artery aneurysm in the National Inpatient Sample from 1988 to 2011. We examined trends in management (open vs EVIR, elective and urgent) and overall isolated iliac artery aneurysm-related deaths (with or without repair). We compared in-hospital mortality and complications for the subgroup of patients undergoing elective open and EVIR from 2000 to 2011.

Results: We identified 33,161 patients undergoing isolated iliac artery aneurysm repair from 1988 to 2011, of which there were 9016 EVIR and 4933 open elective repairs from 2000 to 2011. Total repairs increased after the introduction of EVIR, from 28 to 71 per 10 million United States (U.S.) population (P < .001). EVIR surpassed open repair in 2003. Total isolated iliac artery aneurysm-related deaths, due to rupture or elective repair, decreased after the introduction of EVIR from 4.4 to 2.3 per 10 million U.S. population (P < .001). However, urgent admissions did not decrease during this time period (15 to 15 procedures per 10 million U.S. population; P = .30). Among elective repairs after 2000, EVIR patients were older (72.4 vs 69.4 years; P = .002) and were more likely to have a history of prior myocardial infarction (14.0% vs 11.3%; P < .001) and renal failure (7.2% vs 3.6%; P < .001). Open repair had significantly higher rate of in-hospital mortality (1.8% vs 0.5%; P < .001) and complications (17.9% vs 6.7%; P < .001) and a longer length of stay (6.7 vs 2.3 days; P < .001).

Conclusions: Treatment of isolated iliac artery aneurysms has increased since the introduction of EVIR and is associated with lower perioperative mortality, despite a higher burden of comorbid illness. Decreasing iliac artery aneurysm-attributable in-hospital deaths are likely related primarily to lower elective mortality with EVIR rather than rupture prevention.

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Figures

Figure 1
Figure 1
Elective and urgent procedures over time, per 10 million U.S. population.
Figure 2
Figure 2
Elective and urgent deaths over time, per 10 million US population.
Figure 3
Figure 3
In-hospital mortality for all isolated iliac aneurysm repairs (elective and urgent) over time.
Figure 4
Figure 4
Elective and urgent procedures over time, per 10 million US population.
See this image and copyright information in PMC

References

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