Division of Endovascular Interventions Mount Sinai Hospital New York 1/23/2019

Case presentation PMHx: 68 y.o. male w/ PMH of HTN, HLD, DM2, TIA, OSA, anemia, prostate Ca (s/p radiation 2010), CAD (CABG 2011, s/p multiple PCIs), ESRD, SSS s/p PPM, carotid stenosis and PAD with prior PTA Presents with b/l LE claudication, R>L lifestyle limiting claudication (+) ABI with Rt ABI=0.82 and Lt ABI=0.87. Medications: Amlodipine, Imdur, Glucophage, aspirin, Plavix and Atorvastatin Hb- 10.0, INR- 1.0, Creatinine- 1.0

Angiogram

CTA: reference CI diameter

CTA at the level of the aneurysm

STRATEGY 8Fr RCFA, 25 cm sheath 5Fr sheath access for visualization Anticoagulation with Heparin 0.014 PV IVUS for sizing

Common Iliac Artery Aneurysms Associated with AAA in most patients (75%) 70% involve CIA Equally involve the left and right CIA 30% bilateral External iliac artery aneurysms rare This is the Bulleted List slide. To create this particular slide, click the NEW SLIDE button on your toolbar and choose the BULLETED LIST format. (Top row, second from left) The Sub-Heading and footnote will not appear when you insert a new slide. If you need either one, copy and paste it from the sample slide. If you choose not to use a Sub-Heading, let us know when you hand in your presentation for clean-up and we’ll adjust where the bullets begin on your master page. Also, be sure to insert the presentation title onto the BULLETED LIST MASTER as follows: Choose View / Master / Slide Master from your menu. Select the text at the bottom of the slide and type in a short version of your presentation title. Click the SLIDE VIEW button in the lower left hand part of your screen to return to the slide show. (Small white rectangle) 7

Uberoi et al, CVIR 2011;34:3-13.

Growth Common Iliac Artery Aneurysms Growth 1mm per year (<3cm) Growth 2-3mm per year (3-5 cm) What about along with AAA? This is the Bulleted List slide. To create this particular slide, click the NEW SLIDE button on your toolbar and choose the BULLETED LIST format. (Top row, second from left) The Sub-Heading and footnote will not appear when you insert a new slide. If you need either one, copy and paste it from the sample slide. If you choose not to use a Sub-Heading, let us know when you hand in your presentation for clean-up and we’ll adjust where the bullets begin on your master page. Also, be sure to insert the presentation title onto the BULLETED LIST MASTER as follows: Choose View / Master / Slide Master from your menu. Select the text at the bottom of the slide and type in a short version of your presentation title. Click the SLIDE VIEW button in the lower left hand part of your screen to return to the slide show. (Small white rectangle) 9

When to repair Common Iliac Artery Aneurysms? Size of native vessels Patient age Rate of growth Pain Size Ease of repair This is the Bulleted List slide. To create this particular slide, click the NEW SLIDE button on your toolbar and choose the BULLETED LIST format. (Top row, second from left) The Sub-Heading and footnote will not appear when you insert a new slide. If you need either one, copy and paste it from the sample slide. If you choose not to use a Sub-Heading, let us know when you hand in your presentation for clean-up and we’ll adjust where the bullets begin on your master page. Also, be sure to insert the presentation title onto the BULLETED LIST MASTER as follows: Choose View / Master / Slide Master from your menu. Select the text at the bottom of the slide and type in a short version of your presentation title. Click the SLIDE VIEW button in the lower left hand part of your screen to return to the slide show. (Small white rectangle) 10

Classification Figure 2 ♦ Classification of isolated CIA aneurysms. According to the suitability of the proximal and distal landing zones, the isolated CIA aneurysms can be classified into 5 categories (A-E). Type A: suitable proximal and distal CIA landing zones. Type B: there is a suitable proximal CIA landing zone, but not one distally; this is divided in B1 when the CIA aneurysm does not extend to the IIA and B2 when the aneurysm extends to the IIA (not illustrated). Type C: there is a suitable distal CIA landing zone, not one proximally. Type D: unsuitable CIA landing zones proximally and distally; this is divided in D1 when the CIA aneurysm does not extend to the IIA and D2 when the aneurysm extends to the IIA (not illustrated). Type E: CIA aneurysms secondary to previous open or endovascular repair. Type E1: CIA aneurysm after previous bifurcated endograft for AAA. Type E2: CIA aneurysm after previous aortomonoiliac endografting for AAA, and the dilatation is relative to the occluder. Type E3 “para-anastomotic” iliac aneurysm after previous open aortic reconstruction. J Endovasc Ther  18, 697-715.

Treatment algorithm

Management: