Although aneurysms of the iliac artery often accompany those of the abdominal aorta in 20–30 % of cases, isolated iliac aneurysms represent merely 2 % of intra-abdominal aneurysmal disease. There is a strong 7:1 male to female predominance. The pathophysiology of these aneurysms is similar to their aortic counterparts, with atherosclerosis and a strong smoking history being the principal etiologies. Approximately half of patients with iliac aneurysms will present asymptomatically. Frank rupture or rapid aneurysmal growth accounts for 20–100 % of symptomatic patients in reported series, with other presentations including chronic pelvic pain, hip pain, heart failure due to arteriovenous fistula formation, and urologic obstructive symptoms.
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