Survey of management of common iliac artery aneurysms by members of the Vascular Society of Great Britain and Ireland

Abstract

Introduction The aim of this study was to determine whether the current management of common iliac artery aneurysms (CIAAs) by vascular surgeons is in tune with existing guidelines for referral. Methods This was a postal survey of members of the Vascular Society of Great Britain and Ireland. The main outcome measures were relative frequency of ruptured CIAA, respondents’ size threshold for surveillance versus intervention, and their management strategies for isolated unilateral CIAAs, bilateral CIAAs and aortoiliac aneurysms. Results Two hundred and eighty-four (anonymous) replies were received (48% response rate). Respondents estimated that a ruptured abdominal aortic aneurysm (AAA) was 25 times more common than a ruptured CIAA. Most surgeons (64%) would wait until a CIAA reached 4cm in diameter before considering intervention. This threshold was not affected by other scenarios such as the presence of a bilateral CIAA or a small (4cm) AAA. Eighty per cent of surgeons would treat a non-ruptured CIAA by stenting, where possible. The majority of surgeons felt that ultrasonography surveillance should be commenced when a CIAA exceeds 1.5cm, with a surveillance interval of 1 year but with more frequent surveillance for CIAAs wider than 3cm. Conclusions Existing guidelines that recommend referral for possible intervention for non-ruptured CIAAs at a diameter of 3cm are out of tune with current practice. Most surgeons in this survey would wait until the diameter was 4cm.