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

2. 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

3. Angiogram

4. CTA: reference CI diameter

5. CTA at the level of the aneurysm

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

7. 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
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8. Uberoi et al, CVIR 2011;34:3-13.

9. Growth Common Iliac Artery Aneurysms
Growth 1mm per year (<3cm)
Growth 2-3mm per year (3-5 cm)
What about along with AAA?
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10. When to repair Common Iliac Artery Aneurysms?
Size of native vessels
Patient age
Rate of growth
Pain
Size
Ease of repair
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11. 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,

12. Treatment algorithm

13. Management: