Safety of coil embolization of the internal iliac artery in endovascular grafting of abdominal aortic aneurysms

Abstract

Coil embolization of one or both IIAs appears to be safe in the setting of endovascular grafting of AAA. Buttock claudication is a relatively significant problem and may limit applicability of this strategy to patients who are unfit for standard open repair.

When Should the Internal Iliac Arteries be Preserved in Patients Undergoing Endovascular or Open Repair of Aortoiliac Aneurysms?

“…These findings are supported by two other recent papers on IIA interruption with endovascular repair of AIAs. 19,20 Although these studies have smaller numbers and only include endovascular aneurysm repair, they support our finding that patients do not experience life-threatening complications after unilateral and bilateral IIA interruption. However, the issue of bilateral IIA interruption remains controversial.…”

Outcome after concomitant unilateral embolization of the internal iliac artery and contralateral external-to-internal iliac artery bypass grafting during endovascular aneurysm repair

“…Thus, it is recommended to preserve blood flow to IIA at least unilaterally as well during EVAR in some manner, and bilateral IIA occlusion should be performed in limited cases. 8,20,24 If both IIAs appear equally suitable for revascularization, preservation of the left IIA might be beneficial for increasing collateral flow to the left colon; 25 however, the results of the present series did not reveal any difference with regard to the side of the reconstructed IIA.…”

“…On the other hand, coil embolization of the bilateral IIAs in EVAR has been considered safer compared with their ligation during open surgery. [20][21][22][23] However, it has been documented that it can lead to ischemic colitis 8 or persistent spinal cord deficiency, 9 and buttock claudication is a major complication with a reported incidence of up to 63%. 24 Unno et al 13 examined the intraoperative penile and gluteal blood flow during EVAR with unilateral IIA occlusion and contralateral IIA revascularization.…”

Sequential Dilatation of the Superior Gluteal Artery Following Coil Embolization of the Internal Iliac Artery and Endovascular Abdominal Aneurysm Repair: A Case Report

“…3,4) Buttock claudication, erectile disturbance, and colon ischemia are listed as complications after IIA embolization. The frequency of buttock claudication is reported as 28%-50% after embolization of the ipsilateral IIA 5,6) and as 31%-80% after embolization of bilateral IIAs.…”

“…1,2) When aneurysms of the common iliac artery (CIA) and/or short length of the CIA are associated with AAA, to prevent endoleak into the AAA, it is necessary to perform coil embolization of the internal iliac artery (IIA) before EVAR for limb extension to the external iliac artery. 3,4) As a negative effect following coil embolization and stent graft placement for AAA, the incidence of buttock claudication is reported to be 28%-50% 5,6) and is dependent on symptoms that are subjectively reported by the patient. We present a case of AAA and aneurysm of right CIA that was treated by embolization of IIA and stent graft placement for AAA.…”