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Objectives: Unlike when performed during iliac aneurysm repair internal iliac artery (IIA) revascularization for occlusive disease has not been extensively reported in the literature. The aim of this study was to evaluate the long term patency of open and endovascular IIA revascularization performed for atherosclerotic aortoiliac occlusive disease (AIOD).
Methods:
Data from consecutive patients undergoing IIA revascularization (open or endovascular) for occlusive disease between January 1994 to December 2014 were retrospectively analyzed. The endpoint of the study was primary patency on follow up imaging and evaluation of anatomical factors affecting patency. Statistical analysis was performed using Kaplan Meier survival analysis.
Results
Seventy three males and 25 females (mean age 65 years; range 39-85) underwent revascularization of 109 IIAs. There were 70 open (bypass, n=34; endarterectomy n=36) and 39 endovascular interventions (balloon angioplasty,19: stenting, 20). Indications for intervention included buttock claudication (73,66.9%), lower limb ischemia (7,6.4%) and need to preserve pelvic perfusion during open aortoiliac reconstruction (29,26.6%). Isolated IIA intervention was performed in 17 IIAs (15/ 17 endovascular), the remaining 92 underwent concomitant aorto / iliac reconstruction. Technical success rate was 100% for open and 97% for endovascular interventions. Median diameter of graft, balloons and stents used for interventions were 7, 5 and 6 mm respectively. There was no perioperative mortality. Post-operative imaging during follow up was available for 77(70.6%) procedures. Over a median imaging follow up of 1.89 years (SD 2.92 years), 22 IIAs occluded for a primary patency rate at 1, 3 and 5 years of 82.2%, 69.7%, and 57.4% respectively. Secondary intervention was performed in only 5 IIAs. There was no
statistically significant difference in long term patency between bypass, endarterectomy and endovascular intervention, (Table 1). Mid-term patency of isolated IIA endovascular intervention was superior to those with concomitant aorto/iliac treatment, 93% vs 80% at 1 year respectively; but was not statistically significant.
Conclusion:
Internal iliac revascularization to treat atherosclerotic occlusive disease is technically feasible and safe. Three quarters of both open and endovascular reconstructions maintain patency in the long term, with no significant difference between open and endovascular intervention.

IIA Intervention (n= 109)	Primary patency (standard error)				P value (Log rank)
	6 months	1 year	3year	5year	p value
Bypass(34)	90.9%(0.06)	85.2%(0.08)	74.6%(0.12)	74.6%(0.12)	0.928
Endarterectomy(36)	78.8%(0.08)	78.8%(0.08)	73.8%(0.09)	73.8%(0.09)	0.928
Endovascular(39)	82.3%(0.07)	82.3%(0.07)	62%(0.10)	62.0%(0.10)	0.928
Isolated IIA(17) interventions	93.3%(0.06)	93.3%(0.06)	84.8%(0.10)	84.8%(0.10)	0.107
AIOD interventions(92)	81.5%(0.05)	79.6%(0.5)	65.4%(0.07)	49.1%(0.09)	0.107