Ruptured Iliac Artery Aneurysms

in Aortic Aneurysmal Disease

Applied

Type

Modification

Confidence

90%

Created

Mar 26, 2026

Evidence

3 sources

Rationale

The section was updated to include critical prognostic data from a recent longitudinal cohort study (Laloo 2022) showing the high risk associated with rupture. Guideline citations were updated to include the 2022 AHA/ACC and 2024 ESVS recommendations, ensuring a balanced international perspective and reinforcing the 3.5 cm threshold for elective intervention. All medical abbreviations were expanded on first use as per instructions.

Evidence

Isselbacher EM, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022;146(24):e334-e482. PMID: 36322642.

This guideline provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets.

Verified source
PubMedDOIOpen PDF
Svetlikov AV. [Review of the European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms: what is new and prospects for development]. Angiol Sosud Khir. 2024;30(2):131-136. PMID: 41801947.
Verified source
PubMedDOI
Laloo R, et al. Postoperative outcomes are significantly worse among patients undergoing repair of ruptured versus unruptured iliac artery aneurysms – a 10-year longitudinal cohort study. BJS. 2022;109(Supplement_7). DOI: 10.1093/bjs/znac242.066.
Verified source
DOI

Content Changes

* Ruptured iliac artery aneurysms (IAA) are uncommon; many coexist with abdominal aortic aneurysm (AAA) and are treated within an aorto-iliac repair strategy.
* Postoperative outcomes are significantly worse for patients undergoing repair of ruptured IAA compared to unruptured cases, with higher rates of morbidity and mortality [@laloo2022-laloo].
* Endovascular aneurysm repair (EVAR) is preferred when anatomy allows, with hypogastric preservation via iliac branch devices (IBD) if feasible; internal iliac artery (IIA) embolization may be necessary but increases risk of buttock claudication and pelvic ischemia [@rutherford2018-rutherford].
* Open repair remains important when endovascular seal/accessseal or access is not possible or in the presence of infection. ConsiderCurrent guidelines recommend elective repair thresholds for intactcommon diseaseiliac (commonartery iliac(CIA) ≥3.5aneurysms cm)at in≥3.5 electivecm contexts[@svs2018] [@svs2018].[@aha2022-isselbacher] [@esvs2024-svetlikov].
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