Management of aorto-iliac aneurysms unsuitable for endovascular treatment in very high-risk patients

Aim. The aim of this study was to analyze the issues related to the management of aorto-iliac aneurysms (AIAs) in a selected population of very high-risk patients (VHRP) where the usual endovascular treatment (ET) of these aneurysms is technically unfeasible. Methods. Twelve very high-risk male patients with infra-renal abdominal aortic aneurysms (AAA) and small common iliac artery aneurysms (IAs) were included in the study. In all the AIAs cases, the ET was unfeasible because of the anatomic characteristics of the aortic neck. While the AAAs were treated surgically, the IAs were not treated immediately. In all the AAAs, an aorto-bisiliac prosthesis was implanted by distal iliac anastomosis inside the aneurismal sac rather than aorto-aortic straight interposition. All the IAs were strictly followed-up by ultrasonography (US) every four months. Results. There were no perioperative deaths. Postoperative complications included only one case of non-lethal stroke (8.4%). The mean period of US-follow-up was 48 months. Only in one patient (8.4%), the ET of IA was necessary during the follow-up period because of a significant increased diameter of the IA (2.8 vs 3.5 cm). However, eight out of the remained 11 patients (72.7%) showed an increase in IAs diameter. No patient developed an aortic or iliac pseudo-aneurysm during the follow-up period. Conclusion. In our opinion, in VHRPs where ET is unfeasible the optimal management of AIAs can be provided by surgically treating only AAAs with aorto-bisiliac prosthesis via anastomosis inside the aneurismal sac and a strict US follow-up for the small IAs; this approach reduces significantly cumulative intraoperative risks and provides a possible easy future ET of IAs.