Contemporary Management of Isolated Iliac Aneurysms: Protocol for Systematic Review and Meta-analysis (Preprint)

BACKGROUND Isolated iliac artery aneurysms (IIAAs) are uncommon, accounting for 2-7% of all abdominal arterial aneurysms. Historically, the mainstay of treatment had been open surgical repair (OSR), but recent advancements in endovascular interventions such as endovascular aneurysm repair (EVAR), iliac stent grafting, and embolisation techniques have improved clinical outcomes. However, there remains a need for clarity regarding the comparative effectiveness, risks, and long-term outcomes of different management approaches. This systematic review and meta-analysis aim to provide a comprehensive assessment of contemporary management strategies for IIAAs. OBJECTIVE This review aims to evaluate the current body of evidence on the 30-day major adverse cardiovascular events (MACE), aneurysm-related mortality, reintervention rate, long-term mortality, and length of hospital stay following endovascular repair and OSR. METHODS A literature search will be conducted in OVID Medline, EMBASE, SCOPUS, Cochrane Library, and ClinicalTrials.gov. Eligible studies include randomised and non-randomised controlled trials and observational studies. The primary outcome is 30-day major adverse cardiovascular events (MACE). The secondary outcomes are aneurysm-related mortality, reintervention rate, long-term mortality, and length of hospital stay. The Cochrane RoB2 tool for randomised controlled trials and Newcastle-Ottawa scale tool for observational trials will be used to assess bias. A meta-analysis of clinically homogenous studies will be performed using RevMan. A narrative systematic summary will be performed for data not amenable to meta-analysis. RESULTS Pilot work, formal searching, and study identification commenced on 23rd July 2025. Screening search results against inclusion and exclusion criteria is currently ongoing, which will be followed by data extraction, risk of bias and quality assessments, and data synthesis. We anticipate submitting the manuscript for peer review by the end of September 2025. CONCLUSIONS This review will synthesise current evidence on the contemporary management strategies for IIAAs. CLINICALTRIAL PROSPERO CRD420250572416; https://www.crd.york.ac.uk/PROSPERO/view/CRD420250572416