Aneurysm: The Evolution Towards the Best Possible Treatment

Repairs of a key artery may be on their way to being a whole lot less painful.

A promising trial underway at UVA suggests that repairing iliac arteries — a group of arteries in the pelvis below the aorta — does not have to come at the expense of other arteries.

This means patients can often fully maintain the lifestyle they lived before surgery and specifically experience pain-free walking.

“People need to know that the treatment of aneurysms is still evolving,” says John “Fritz” Angle, MD, a principal investigator in the trial. “We are very engaged and interested in helping anyone with the diagnosis of aneurysm find the best possible treatment.”

What Are Iliac Arteries, Exactly?

The group of arteries include the common, external and internal iliac arteries, and play a role in carrying blood to the pelvis, legs, colon and reproductive organs.

Although iliac aneurysms are not very common, their effects can be severe, and include:

• Erectile dysfunction
• Back pain
• Lower abdominal pain
• Groin pain
• Death

People are often unaware of their iliac artery issues, according to Gilbert R. Upchurch Jr., MD, who says doctors diagnose the aneurysm with a CT scan.

Older, male smokers have the highest risk of developing an iliac aneurysm.

While the standard treatment for common iliac aneurysm involves the insertion of a graft into the patient, the procedure can come at the expense of the internal iliac artery, leading to serious colon problems, buttock pain, sexual side effects  and generally “a lot of patient dissatisfaction,” according to Upchurch.

The trial treatment underway at UVA seeks to maintain blood flow to the internal iliac artery during surgery by placing a device that preserves blood flow to the artery when treating the common iliac aneurysm.

“When the aneurysm extends down into those pelvis branches, we previously would have to block off one of the branches and run the graft into the other branch, and that usually is well tolerated, but not always,” Angle says. “Sometimes we still have to do this, but this study has given us an alternative, which helps us specifically save the internal iliac artery.”

The continuation of blood flow to the internal iliac artery means patients are far less likely to suffer complications or long-term pain.

UVA was part of the initial trial of 40 patients in the U.S. and two were enrolled at UVA.  Based on the promising results, doctors will continue with the treatment at select sites across the country, including UVA.

Aneurysm and Cancer: One Patient’s Story

So far the results of the clinical trial have been positive for Mitchell Carr. The 77-year-old Staunton, Va., resident first learned of an iliac aneurysm years ago.

At the time his UVA doctors said a trouble spot on one of his arteries was cause for concern, but did not require urgent care.

A subsequent diagnosis of prostate cancer also came with the warning that an aneurysm was increasing in size.

While the normal course of action would likely involve a metal stent, Carr’s doctors warned him that the stents could interfere with the imaging and radiation treatment needed for his cancer care.

That’s when John Kern, MD, told him about a new kind of stent that would not disrupt his cancer treatment and could save his lateral blood vessels, as well.

Carr knew the trial came with risks, but said he trusted the doctors and knew they were trying to save his life.

The procedure took a few hours and required Carr to submit to his first-ever overnight stay in a hospital.  Since then,  it’s been mostly a case of “so far, so good,” although Carr said he was at times noticeably chillier in the weeks following the surgery.

Throughout the process, Carr said he remained impressed with the care and professionalism provided by his team at UVA.

“Luckily everything turned out really good,” Carr said. “I’m very pleased.”

Iliac Aneurysm Treatment Continues

Given the encouraging early results, Angle says the treatment continues at UVA, even though the initial trial has closed.

“It was a very small study because it is not a common scenario, but we’re very fortunate here at UVA that we have the device here on a limited basis for patients that really need it,” says Angle.

Learn more about iliac aneurysms at UVA.