Skip to main content
Erschienen in: CardioVascular and Interventional Radiology 2/2008

01.03.2008 | Clinical Investigation

How Safe is Bilateral Internal Iliac Artery Embolization Prior to EVAR?

verfasst von: M. J. Bratby, G. M. Munneke, A.-M. Belli, T. M. Loosemore, I. Loftus, M. M. Thompson, R. A. Morgan

Erschienen in: CardioVascular and Interventional Radiology | Ausgabe 2/2008

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To assess the outcomes of patients after bilateral internal iliac artery (IIA) embolization prior to endovascular aneurysm repair (EVAR).

Methods

Thirty-nine patients (age range 55–88 years, mean 72.5 years; 2 women) underwent IIA embolization/occlusion before EVAR. There were 28 patients with aorto-biiliac aneurysms and 6 with bilateral common iliac artery (CIA) aneurysms. Five patients with unilateral CIA aneurysms had previous surgical ligation of the contralateral IIA or inadvertent covering by the stent-graft of the contralateral IIA origin. Outcomes were assessed by clinical follow-up.

Results

Severe ischemic complications were limited to spinal cord ischemia in 1 patient (3%) who developed paraparesis following EVAR. No other severe ischemic complications such as buttock necrosis, or bowel or bladder ischemia, occurred. Buttock and/or thigh claudication occurred in 12 patients (31%) and persisted beyond 1 year in 3 patients (9%). Sexual dysfunction occurred in 2 patients (5%). Patients who underwent simultaneous embolization had a 25% (3/12) ischemic complication rate versus 41% (11/27) in those with sequential embolization (p = 0.48). Embolization limited to the main trunk of the IIA resulted in a significantly reduced ischemic complication rate of 16% (3/19) versus 55% (11/20) of patients who had a more distal embolization of the IIA (p = 0.019, Fisher’s exact test).

Conclusion

Severe complications after bilateral IIA embolization are uncommon. Although buttock/thigh claudication occurs in around 30% of patients soon after the procedure, this resolves in the majority after 1 year. There is no obvious benefit for sequential versus simultaneous IIA embolization in our series. Occlusion of the proximal IIA trunk is associated with reduced complications compared with occlusion of the distal IIA.
Literatur
1.
Zurück zum Zitat Soulen MC, Fairman RM, Baum RA (2000) Embolization of the internal iliac artery: Still more to learn. J Vasc Interv Radiol 11:543–545PubMedCrossRef Soulen MC, Fairman RM, Baum RA (2000) Embolization of the internal iliac artery: Still more to learn. J Vasc Interv Radiol 11:543–545PubMedCrossRef
2.
Zurück zum Zitat Armon MP, Wenham PW, Whitaker SC, Gregson RH, Hopkinson BR (1998) Common iliac artery aneurysms in patients with abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 15:255–257PubMedCrossRef Armon MP, Wenham PW, Whitaker SC, Gregson RH, Hopkinson BR (1998) Common iliac artery aneurysms in patients with abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 15:255–257PubMedCrossRef
3.
Zurück zum Zitat Mehta M, Veith FJ, Ohki T, et al. (2001) Unilateral and bilateral hypogastric artery interruption during aortoiliac aneurysm repair in 154 patients: A relatively innocuous procedure. J Vasc Surg 33:S27–32PubMedCrossRef Mehta M, Veith FJ, Ohki T, et al. (2001) Unilateral and bilateral hypogastric artery interruption during aortoiliac aneurysm repair in 154 patients: A relatively innocuous procedure. J Vasc Surg 33:S27–32PubMedCrossRef
4.
Zurück zum Zitat Razavi MK, DeGroot M, Olcott C 3rd, et al. (2000) Internal iliac artery embolization in the stent-graft treatment of aortoiliac aneurysms: Analysis of outcomes and complications. J Vasc Interv Radiol 11:561–566PubMedCrossRef Razavi MK, DeGroot M, Olcott C 3rd, et al. (2000) Internal iliac artery embolization in the stent-graft treatment of aortoiliac aneurysms: Analysis of outcomes and complications. J Vasc Interv Radiol 11:561–566PubMedCrossRef
5.
Zurück zum Zitat Yano OJ, Morrissey N, Eisen L, et al. (2001) Intentional internal iliac artery occlusion to facilitate endovascular repair of aortoiliac aneurysms. J Vasc Surg 34:204–211PubMedCrossRef Yano OJ, Morrissey N, Eisen L, et al. (2001) Intentional internal iliac artery occlusion to facilitate endovascular repair of aortoiliac aneurysms. J Vasc Surg 34:204–211PubMedCrossRef
6.
Zurück zum Zitat Lee CW, Kaufman JA, Fan CM, et al. (2000) Clinical outcome of internal iliac artery occlusions during endovascular treatment of aortoiliac aneurysmal diseases. J Vasc Interv Radiol 11:567–571PubMedCrossRef Lee CW, Kaufman JA, Fan CM, et al. (2000) Clinical outcome of internal iliac artery occlusions during endovascular treatment of aortoiliac aneurysmal diseases. J Vasc Interv Radiol 11:567–571PubMedCrossRef
7.
Zurück zum Zitat Cynamon J, Lerer D, Veith FJ, et al. (2000) Hypogastric artery coil embolization prior to endoluminal repair of aneurysms and fistulas: Buttock claudication, a recognized but possibly preventable complication. J Vasc Interv Radiol 11:573–577PubMedCrossRef Cynamon J, Lerer D, Veith FJ, et al. (2000) Hypogastric artery coil embolization prior to endoluminal repair of aneurysms and fistulas: Buttock claudication, a recognized but possibly preventable complication. J Vasc Interv Radiol 11:573–577PubMedCrossRef
8.
Zurück zum Zitat Bayly PJ, Matthews JN, Dobson PM, Price ML, Thomas DG (2001) In-hospital mortality from abdominal aortic surgery in Great Britain and Ireland: Vascular Anaesthesia Society audit. Br J Surg 88:687–692PubMedCrossRef Bayly PJ, Matthews JN, Dobson PM, Price ML, Thomas DG (2001) In-hospital mortality from abdominal aortic surgery in Great Britain and Ireland: Vascular Anaesthesia Society audit. Br J Surg 88:687–692PubMedCrossRef
9.
Zurück zum Zitat Melliere D, Berrahal D, Desgranges P, Allaire E, Becquemin JP (1998) Hypogastric arterial aneurysms associated with abdominal aortic aneurysms. J Mal Vasc 23:342–348PubMed Melliere D, Berrahal D, Desgranges P, Allaire E, Becquemin JP (1998) Hypogastric arterial aneurysms associated with abdominal aortic aneurysms. J Mal Vasc 23:342–348PubMed
10.
Zurück zum Zitat Mehta M, Veith FJ, Darling RC, et al. (2004) Effects of bilateral hypogastric artery interruption during endovascular and open aortoiliac aneurysm repair. J Vasc Surg 40:698–702PubMedCrossRef Mehta M, Veith FJ, Darling RC, et al. (2004) Effects of bilateral hypogastric artery interruption during endovascular and open aortoiliac aneurysm repair. J Vasc Surg 40:698–702PubMedCrossRef
11.
Zurück zum Zitat Andriole GL, Sugarbaker PH (1985) Perineal and bladder necrosis following bilateral internal iliac artery ligation: Report of a case. Dis Colon Rectum 28:183–184PubMedCrossRef Andriole GL, Sugarbaker PH (1985) Perineal and bladder necrosis following bilateral internal iliac artery ligation: Report of a case. Dis Colon Rectum 28:183–184PubMedCrossRef
12.
Zurück zum Zitat Senapati A, Browse NL (1990) Gluteal necrosis and paraplegia following postoperative bilateral internal iliac artery occlusion. J Cardiovasc Surg (Torino) 31:194–196 Senapati A, Browse NL (1990) Gluteal necrosis and paraplegia following postoperative bilateral internal iliac artery occlusion. J Cardiovasc Surg (Torino) 31:194–196
13.
Zurück zum Zitat Gloviczki P, Cross SA, Stanson AW, et al. (1991) Ischemic injury to the spinal cord or lumbosacral plexus after aorto-iliac reconstruction. Am J Surg 162:131–136PubMedCrossRef Gloviczki P, Cross SA, Stanson AW, et al. (1991) Ischemic injury to the spinal cord or lumbosacral plexus after aorto-iliac reconstruction. Am J Surg 162:131–136PubMedCrossRef
14.
Zurück zum Zitat Cikrit DF, O’Donnell DM, Dalsing MC, Sawchuk AP, Lalka SG (1991) Clinical implications of combined hypogastric and profunda femoral artery occlusion. Am J Surg 162:137–140; discussion 140–131PubMedCrossRef Cikrit DF, O’Donnell DM, Dalsing MC, Sawchuk AP, Lalka SG (1991) Clinical implications of combined hypogastric and profunda femoral artery occlusion. Am J Surg 162:137–140; discussion 140–131PubMedCrossRef
15.
Zurück zum Zitat Paty PK, Shah DM, Chang BB, Darling RC 3rd, Leather RP (1994) Pelvic ischemia following aortoiliac reconstruction. Ann Vasc Surg 8:204–206PubMedCrossRef Paty PK, Shah DM, Chang BB, Darling RC 3rd, Leather RP (1994) Pelvic ischemia following aortoiliac reconstruction. Ann Vasc Surg 8:204–206PubMedCrossRef
16.
Zurück zum Zitat Shin RK, Stecker MM, Imbesi SG (2001) Peripheral nerve ischaemia after internal iliac artery ligation. J Neurol Neurosurg Psychiatry 70:411–412PubMedCrossRef Shin RK, Stecker MM, Imbesi SG (2001) Peripheral nerve ischaemia after internal iliac artery ligation. J Neurol Neurosurg Psychiatry 70:411–412PubMedCrossRef
17.
Zurück zum Zitat Picone AL, Green RM, Ricotta JR, May AG, DeWeese JA (1986) Spinal cord ischemia following operations on the abdominal aorta. J Vasc Surg 3:94–103PubMedCrossRef Picone AL, Green RM, Ricotta JR, May AG, DeWeese JA (1986) Spinal cord ischemia following operations on the abdominal aorta. J Vasc Surg 3:94–103PubMedCrossRef
18.
Zurück zum Zitat Iliopoulos JI, Howanitz PE, Pierce GE, Kueshkerian SM, Thomas JH, Hermreck AS (1987) The critical hypogastric circulation. Am J Surg 154:671–675PubMedCrossRef Iliopoulos JI, Howanitz PE, Pierce GE, Kueshkerian SM, Thomas JH, Hermreck AS (1987) The critical hypogastric circulation. Am J Surg 154:671–675PubMedCrossRef
19.
Zurück zum Zitat Schoder M, Zaunbauer L, Holzenbein T, et al. (2001) Internal iliac artery embolization before endovascular repair of abdominal aortic aneurysms: Frequency, efficacy, and clinical results. AJR Am J Roentgenol 177:599–605PubMed Schoder M, Zaunbauer L, Holzenbein T, et al. (2001) Internal iliac artery embolization before endovascular repair of abdominal aortic aneurysms: Frequency, efficacy, and clinical results. AJR Am J Roentgenol 177:599–605PubMed
20.
Zurück zum Zitat Engelke C, Elford J, Morgan RA, Belli AM (2002) Internal iliac artery embolization with bilateral occlusion before endovascular aortoiliac aneurysm repair-clinical outcome of simultaneous and sequential intervention. J Vasc Interv Radiol 13:667–676PubMedCrossRef Engelke C, Elford J, Morgan RA, Belli AM (2002) Internal iliac artery embolization with bilateral occlusion before endovascular aortoiliac aneurysm repair-clinical outcome of simultaneous and sequential intervention. J Vasc Interv Radiol 13:667–676PubMedCrossRef
21.
Zurück zum Zitat Wolpert LM, Dittrich KP, Hallisey MJ, et al. (2001) Hypogastric artery embolization in endovascular abdominal aortic aneurysm repair. J Vasc Surg 33:1193–1198PubMedCrossRef Wolpert LM, Dittrich KP, Hallisey MJ, et al. (2001) Hypogastric artery embolization in endovascular abdominal aortic aneurysm repair. J Vasc Surg 33:1193–1198PubMedCrossRef
22.
Zurück zum Zitat Criado FJ, Wilson EP, Velazquez OC, et al. (2000) Safety of coil embolization of the internal iliac artery in endovascular grafting of abdominal aortic aneurysms. J Vasc Surg 32:684–688PubMedCrossRef Criado FJ, Wilson EP, Velazquez OC, et al. (2000) Safety of coil embolization of the internal iliac artery in endovascular grafting of abdominal aortic aneurysms. J Vasc Surg 32:684–688PubMedCrossRef
23.
Zurück zum Zitat Kwok PC, Chung TK, Chong LC, et al. (2001) Neurologic injury after endovascular stent-graft and bilateral internal iliac artery embolization for infrarenal abdominal aortic aneurysm. J Vasc Interv Radiol 12:761–763PubMedCrossRef Kwok PC, Chung TK, Chong LC, et al. (2001) Neurologic injury after endovascular stent-graft and bilateral internal iliac artery embolization for infrarenal abdominal aortic aneurysm. J Vasc Interv Radiol 12:761–763PubMedCrossRef
24.
Zurück zum Zitat Iliopoulos JI, Hermreck AS, Thomas JH, Pierce GE (1989) Hemodynamics of the hypogastric arterial circulation. J Vasc Surg 9:637–641; discussion 641–642PubMedCrossRef Iliopoulos JI, Hermreck AS, Thomas JH, Pierce GE (1989) Hemodynamics of the hypogastric arterial circulation. J Vasc Surg 9:637–641; discussion 641–642PubMedCrossRef
25.
Zurück zum Zitat Karch LA, Hodgson KJ, Mattos MA, Bohannon WT, Ramsey DE, McLafferty RB (2000) Adverse consequences of internal iliac artery occlusion during endovascular repair of abdominal aortic aneurysms. J Vasc Surg 32:676–683PubMedCrossRef Karch LA, Hodgson KJ, Mattos MA, Bohannon WT, Ramsey DE, McLafferty RB (2000) Adverse consequences of internal iliac artery occlusion during endovascular repair of abdominal aortic aneurysms. J Vasc Surg 32:676–683PubMedCrossRef
26.
Zurück zum Zitat Kritpracha B, Pigott JP, Price CI, Russell TE, Corbey MJ, Beebe HG (2003) Distal internal iliac artery embolization: A procedure to avoid. J Vasc Surg 37:943–948PubMedCrossRef Kritpracha B, Pigott JP, Price CI, Russell TE, Corbey MJ, Beebe HG (2003) Distal internal iliac artery embolization: A procedure to avoid. J Vasc Surg 37:943–948PubMedCrossRef
27.
Zurück zum Zitat Wyers MC, Schermerhorn ML, Fillinger MF, et al. (2002) Internal iliac occlusion without coil embolization during endovascular abdominal aortic aneurysm repair. J Vasc Surg 36:1138–1145PubMedCrossRef Wyers MC, Schermerhorn ML, Fillinger MF, et al. (2002) Internal iliac occlusion without coil embolization during endovascular abdominal aortic aneurysm repair. J Vasc Surg 36:1138–1145PubMedCrossRef
28.
Zurück zum Zitat Tefera G, Turnipseed WD, Carr SC, Pulfer KA, Hoch JR, Acher CW (2004) Is coil embolization of hypogastric artery necessary during endovascular treatment of aortoiliac aneurysms? Ann Vasc Surg 18:143–146PubMedCrossRef Tefera G, Turnipseed WD, Carr SC, Pulfer KA, Hoch JR, Acher CW (2004) Is coil embolization of hypogastric artery necessary during endovascular treatment of aortoiliac aneurysms? Ann Vasc Surg 18:143–146PubMedCrossRef
29.
Zurück zum Zitat Mell M, Tefera G, Schwarze M, et al. (2006) Absence of buttock claudication following stent-graft coverage of the hypogastric artery without coil embolization in endovascular aneurysm repair. J Endovasc Ther 13:415–419PubMedCrossRef Mell M, Tefera G, Schwarze M, et al. (2006) Absence of buttock claudication following stent-graft coverage of the hypogastric artery without coil embolization in endovascular aneurysm repair. J Endovasc Ther 13:415–419PubMedCrossRef
30.
Zurück zum Zitat Rajasinghe HA, Pigott JP, Kritpracha B, Corbey MJ, Beebe HG (2003) Internal iliac artery occlusion using a stent-graft tunnel during endovascular aneurysm repair: A new alternative to coil embolization. J Endovasc Ther 10:1082–1086PubMedCrossRef Rajasinghe HA, Pigott JP, Kritpracha B, Corbey MJ, Beebe HG (2003) Internal iliac artery occlusion using a stent-graft tunnel during endovascular aneurysm repair: A new alternative to coil embolization. J Endovasc Ther 10:1082–1086PubMedCrossRef
31.
Zurück zum Zitat Delle M, Lonn L, Wingren U, et al. (2005) Preserved pelvic circulation after stent-graft treatment of complex aortoiliac artery aneurysms: A new approach. J Endovasc Ther 12:189–195PubMedCrossRef Delle M, Lonn L, Wingren U, et al. (2005) Preserved pelvic circulation after stent-graft treatment of complex aortoiliac artery aneurysms: A new approach. J Endovasc Ther 12:189–195PubMedCrossRef
32.
Zurück zum Zitat Unno N, Inuzuka K, Yamamoto N, Sagara D, Suzuki M, Konno H (2006) Preservation of pelvic circulation with hypogastric artery bypass in endovascular repair of abdominal aortic aneurysm with bilateral iliac artery aneurysms. J Vasc Surg 44:1170–1175PubMedCrossRef Unno N, Inuzuka K, Yamamoto N, Sagara D, Suzuki M, Konno H (2006) Preservation of pelvic circulation with hypogastric artery bypass in endovascular repair of abdominal aortic aneurysm with bilateral iliac artery aneurysms. J Vasc Surg 44:1170–1175PubMedCrossRef
33.
Zurück zum Zitat Haulon S, Greenberg RK, Pfaff K, Francis C, Koussa M, West K (2007) Branched grafting for aortoiliac aneurysms. Eur J Vasc Endovasc Surg 33:567–574PubMedCrossRef Haulon S, Greenberg RK, Pfaff K, Francis C, Koussa M, West K (2007) Branched grafting for aortoiliac aneurysms. Eur J Vasc Endovasc Surg 33:567–574PubMedCrossRef
Metadaten
Titel
How Safe is Bilateral Internal Iliac Artery Embolization Prior to EVAR?
verfasst von
M. J. Bratby
G. M. Munneke
A.-M. Belli
T. M. Loosemore
I. Loftus
M. M. Thompson
R. A. Morgan
Publikationsdatum
01.03.2008
Verlag
Springer-Verlag
Erschienen in
CardioVascular and Interventional Radiology / Ausgabe 2/2008
Print ISSN: 0174-1551
Elektronische ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-007-9203-6

Weitere Artikel der Ausgabe 2/2008

CardioVascular and Interventional Radiology 2/2008 Zur Ausgabe

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.