Technical threshold for endovascular repair in isolated common iliac artery aneurysms based on loss of the proximal landing zone at smaller diameters

Le résumé fourni par la source

Objective Current guidelines recommend increasing diameter thresholds for intervention in isolated iliac artery aneurysms based on rupture risk. However, anatomical feasibility and procedural complexity have not been fully considered. This study evaluated the relationship between aneurysm size and endovascular treatment strategy. Methods We conducted a retrospective single-center study of 36 patients with nonruptured, asymptomatic solitary unilateral common iliac artery aneurysms treated with endovascular aneurysm repair (EVAR) between 2013 and 2025. Patients were stratified by aneurysm diameter (≥35 mm vs <35 mm). Anatomical characteristics, procedural details, and outcomes were compared. Correlation analysis and receiver operating characteristic (ROC) analysis were performed. Results Bifurcated EVAR was more frequently required in aneurysms ≥35 mm (94.1% vs 42.1%; P=.001), with longer operative time, greater blood loss, and higher device cost. Aneurysm diameter was inversely correlated with proximal common iliac artery length (ρ = −0.531; P < .001). ROC analysis identified a cutoff of 33.2 mm for predicting proximal landing zone ≤10 mm (AUC, 0.836). Conclusions Increasing aneurysm size is associated with loss of anatomical suitability for less invasive EVAR. A diameter of approximately 33 mm may represent a clinically relevant technical threshold for anticipating loss of an adequate proximal landing zone. This value should not be interpreted as a rupture-based threshold for intervention, but rather as a technical consideration for EVAR planning in patients being considered for repair.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.