SIAA 41 SIAA. + F-F 7 MIVS minimal invasive vascular surgery 3 IIAA 6 CIAA + IIAA 1

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1 SIAA 41 SIAA cm / 41AAA / 658 SIAASIAA / 41 SIAACIAA / 41 IIAA / 41IIAA AAA SIAA / / 2 Y / 41CIAA + F-F 7 MIVS minimal invasive vascular surgery 3 IIAA 6 CIAA + IIAA 1 SIAA AAAY AAA SIAA SIAA 41retrospective SIAA Tel: AAA SIAA unpaired Student s t 2 2χ 2 p <.5 1. CIAA SIAA / IIAA SIAA / CIAA IIAASIAA7.3 3 / 41 EIAA 1 Fig. 1 25

2 right left bilateral % 41.9% rupture unrupture 4 2 CIA CIA+IIA IIA EIA Total CIA 1% IIA CIA+IIA Fig. 1 The number according to location of SIAA. Fig. 2 Rupture frequency classified by location with regard to SIAA. 2. SIAA CIAA IIAA 7 Fig SIAA cm6. 1.9cm cm cm cm cm p =.2 4. AAASIAA AAA / 658SIAA / 41 AAA p =.8CT AAA cm SIAA cmAAA / 53 SIAA2. 4 / 2 SIAA AAA 5. CIAA 31 6 Y- 25Y F-F 7 MIVS 3 Y- Fig. 3 F-F S-graft others CIA F-F S-graft others The surgical procedures for SIAA in our clinic. S-graft: straight graft F-F: femoro-femoro crossover IIAA Y- + endoaneurysmorrhaphy Y- + IIAA IIAA 1 9 Fig CIAA 2 IIAA 2 SIAA IIA CIA+ IIA

3 / 2 1 SIAA / SIAA / / , 2 AAA ~ SIAA CIAA / 198 IIAA / 198 CIAA + IIAA / 198 EIAA 1. 2 / 198 CIAA / 41 IIAA / 41 CIAA + IIAA / 41EIAA 1 CIAA EIAA 21 SIAA Y / / 41 1 IIAA2 IIAA CIAA CIAA + IIAA IIAA endoaneurysmorrhaphy 7, 12 18, 19 IIAAIIA / IIAA IIAA high risk IIAA / 41 CIAA 9 IIAA 9 IIAA 9 2 CIAA 1 IIAA CIAA IIAA poor risk Endoaneurys-morrhaphy 7, 8 IIAA distal side IIAA / 52IIAA 1 IIAA SIAA / / 41 AAA16 21 / / 658 AAA SIAA / / 41Table SIAA AAA 2 SIAA 3.cm 8 SIAA SIAA QOL CIAA IIAA good risk high risk CIAA high risk + F-F 23, good risky- MIVS 27

4 13 7 Table 1 Comparsion of reporters series and authors series with regard to SIAA Reporters series Authors series p-value Total patients Male/Female ratio 12 : 1 (183/15) 8 : 1 (35/6) p=.2793 Mean age years years Relative incidence 7.9% (73/918) 6.1% (41/658) p=.2258 Location CIA 57.1% (113/198) 75.6% (31/41)* p=.34 IIA 26.3% (52/198) 17.1% (7/41) p=.3629 Mixed 15.7% (31/198) 7.3% (3/41) p=.2219 ing incidence 49.7% (96/193) 58.5% (21/41) p=.8734 Rupture incidence 36.4% (72/198) 48.8% (2/41) p=.1369 Mortality 6.8% 11.1% p=.8832 *p<.5 CIAA Ipsilateral Bilateral High risk Good risk High risk Good risk Coil or ligation and F-F crossover bypass or straight bypass (MIVS) aneurysmectomy aneurysmectomy Fig. 4a Strategy for CIAA. IIAA Ipsilateral Bilateral High risk Good risk High risk Good risk Ligation or coil emboli Endoaneurysmorrhaphy Ligation or coil emboli and reconstruction of IIA endoaneurysmorrhaphy Fig. 4b Strategy for IIAA. high risk Y- good risk Y-Fig. 4a IIAA high risk good riskendoaneurysmorrhaphyhigh risk good risk Y- + endoaneurysmorrhaphy Fig. 4bSIAA 28

5 24 12 AAASIAA SIAA SIAA IIAA 38 1 IIAA 6 4 MIVS 29, 3 high risk SIAA 25, 26 SIAA SIAA device SIAA high risk SIAA AAA risk Minato, N., Itoh, T., Natsuaki, M., et al.: Isolated iliac artery aneurysm and its management. Cardiovasc. Surg., 2: , Shindo, S., Kubota, K., Kojima, A., et al.: Inflammatory solitary iliac artery aneurysm: a report of two cases. Cardiovasc. Surg., 9: , Katho, J., Shindo, S. and Kina, S.: Rupture of an isolated internal iliac artery aneurysm into the rectum. Surgery Today, 25: , Katagiri, M. and Kasuya, S.: Surgery for an isolated aneurysm of the internal iliac artery. J. Cardovasc. Surg., 31: , Lowry, W. F. and Kraft, R. O.: Isolated aneurysms of the iliac artery. Arch. Surg., 113: , Lallemand, R. C., Gosling, R. G. and Newman, D. L.: Role of the bifurcation in atheromatosis of the abdominal aorta. Surgery, Gyn & Obs., 137: ,

6 Reuter, S. R. and Carson, S. N.: Thrombosis of common iliac artery aneurysm by selective embolization and extra anatomic bypass. AJR, 134: , Razavi, M. K., Dake, M. D., Semba, C. P., et al.: Percutaneous endoluminal placement of stent-grafts for the treatment of isolated iliac artery aneurysms. Radiology, 197: 81-84, Dorros, G., Cohn, J. M. and Jaff, M. R.: Percutaneous endovascular stent-graft repair of iliac artery aneurysms. J. Endovasc. Surg., 4: , Sahgal, A., Veith, J. F., Lipsitz, E., et al.: Diameter changes in isolated iliac artery aneurysms 1 to 6 years after endovascular graft repair. J. Vasc. Surg., 33: , Sacks, N. P. M., Huddy, S. P. J., Chir, M., et al.: Management of solitary iliac aneurysms. J. Cardiovasc. Surg., 33: , Krupski, W. C., Selzman, C. H., Frorida, R., et al.: Contemporary management of isolated iliac aneurysms. J. Vasc. Surg., 28: 1-13, Strategy for Solitary Iliac Artery Aneurysms Shinichi Hiromatsu, Hiroko Yokokura, Kenji Ishihara, Teiji Okazaki, Seiji Onitsuka, Keiichiro Tayama, Hidetoshi Akashi and Shigeaki Aoyagi Department of Surgery, Kurume University School of Medicine Key words: Solitary iliac artery aneurysm, Minimal invasive vascular surgery, Endovascular repair We retrospectively reviewed 41 patients with solitary iliac artery aneurysms (SIAA), presenting over a 2 year period. The mean age was years. The mean aneurysm diameter was cm. In 31 cases the aneurysm involved the common iliac artery and in 7 cases the internal iliac artery. Rupture occurred in 2 patients (48.8%). During the same period, 658 patients with abdominal aortic aneurysm (AAA) underwent surgery, of which 53 cases had ruptured (8.1%). The frequency of rupture of SIAA was significantly higher than that of AAA. The 3-day mortality was 9.7%(4 patient), all of which were rupture cases. The mortality of ruptured AAA and SIAA was not significantly different (28.3% and 2.%, respectively). The most frequent procedure was aneurysmectomy and replacement with a bifurcated prosthetic graft in 24 cases (58.5%). Closure of the common iliac artery with a femoro-femoro crossover was performed in 7 cases and minimally invasive vascular surgery was performed in 3 cases. For internal iliac aneurysms, the procedure was in 6 cases. Endovascular repair was performed in one case for multiple iliac artery aneurysms. The surgical procedures for SIAA can be methods other than replacement with bifurcated prosthetic grafts. In selecting the strategy for SIAA, it is important to choose an approach appropriate to location and risk, because of the frequency rupture. Jpn. J. Vasc. Surg., 13: , 24 3