CLINICAL INVESTIGATION Predictors of Reintervention After Endovascular Repair of Isolated Iliac Artery Aneurysm Hany A. Zayed • Rizwan Attia • Bijan Modarai • Rachel E. Clough • Rachel E. Bell • Tom Carrell • Tarun Sabharwal • John Reidy • Peter R. Taylor Received: 15 December 2009 / Accepted: 15 April 2010 / Published online: 13 May 2010 Ó Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2010 Abstract The objective of this study was to identify factors predicting the need for reintervention after endo- vascular repair of isolated iliac artery aneurysm (IIAA). We reviewed prospectively collected database records of all patients who underwent endovascular repair of IIAA between 1999 and 2008. Detailed assessment of the aneu- rysms was performed using computed tomography angi- ography (CTA). Follow-up protocol included CTA at 3 months. If this showed no complication, then annual duplex scan was arranged. Multivariate analysis and anal- ysis of patient survival and freedom from reintervention were performed using Kaplan–Meier life tables. Forty IIAAs (median diameter 44 mm) in 38 patients were treated (all men; median age 75 years), and median follow- up was 27 months. Endovascular repair of IIAA was required in 14 of 40 aneurysms (35%). The rate of type I endoleak was significantly higher with proximal landing zone (PLZ) diameter [ 30 mm in the aorta or [ 24 mm in the common iliac artery or distal landing zone (DLZ) diameter [ 24 mm (P = 0.03, 0.03, and 0.0014, respec- tively). Reintervention rate (RR) increased significantly with increased diameter or decreased length of PLZ; increased DLZ diameter; and endovascular IIAA repair (P = 0.005, 0.005, 0.02, and 0.02 respectively); however, RR was not significantly affected by length of PLZ or DLZ. Freedom-from-reintervention was 97, 93, and 86% at 12, 24, and 108 months. There was no in-hospital or aneurysm- related mortality. Endovascular IIAA repair is a safe treatment option. Proper patient selection is essential to decrease the RR. Keywords Iliac artery aneurysms Á Endovascular repair Á Reintervention Introduction Iliac artery aneurysms can present as aortoiliac aneurysms in 20 to 25% of patients with aortic aneurysms [1], or less commonly as isolated iliac artery aneurysms (IIAAs) in \ 0.1% of the population [2], and constitute \ 2% of all intra-abdominal aneurysms [3]. IIAAs have been defined as any dilatation of the common iliac artery (CIA) or the external iliac artery (EIA) or an IIAA [ 1.5 cm in diameter with an aortic diameter \ 3.5 cm. IIAAs are characterised by slow expansion rate, with no rupture reported in aneu- rysms \ 3 cm; however, rupture rates range from 15 to 70% in larger aneurysms [1]. Therefore, IIAA repair is recom- mended when the IIAA diameter reaches 3 to 4 cm [4]. Most IIAAs are asymptomatic, however, patients may present with rupture, distal embolisation, thrombosis, or symptoms of compression of adjacent structures [5]. Because of the high operative mortality rate associated with ruptured IIAAs, which ranges from 33 to 50%, elec- tive repair of patients with significant risk of rupture is recommended. Open surgical repair used to be the ‘‘gold standard’’ for IIAAs repair; however, it is technically challenging because of the deep pelvic location and the frequent history of aortic aneurysm repair, which accoun- ted for the relatively high mortality of approximately 10% in one large series [1]. Recent reports, however, suggest improved results [6]. Endovascular IIAA repair is now considered a good alternative to open surgery, with lower H. A. Zayed (&) Á R. Attia Á B. Modarai Á R. E. Clough Á R. E. Bell Á T. Carrell Á T. Sabharwal Á J. Reidy Á P. R. Taylor Guy’s and St. Thomas’ NHS Foundation Trust, First floor, North wing, Westminster Bridge Road, SE1 7EH London, UK e-mail: hany.zayed@gstt.nhs.uk 123 Cardiovasc Intervent Radiol (2011) 34:61–66 DOI 10.1007/s00270-010-9876-0