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Internal Iliac Artery Embolization Before Endovascular Repair of Abdominal Aortic Aneurysms

Frequency, Efficacy, and Clinical Results

¹ Department of Angiography and Interventional Radiology, AKH-University Clinics, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
² Department of Surgery, Barmherzige Schwestern, Stumpergasse 6, A-1060 Vienna, Austria.
³ Department of Vascular Surgery, AKH-University Clinics, A-1090 Vienna, Austria.
⁴ Ludwig Bolzmann Institute of Vascular Medicine, A-1090 Vienna, Austria.

OBJECTIVE. The aim of our study was to assess the frequency, efficacy, and incidence of adverse effects of internal iliac artery embolization.

MATERIALS AND METHODS. Of 343 patients examined for stent-graft repair, 147 were suitable for endovascular treatment. Fifty-five patients underwent preprocedural embolization of the internal iliac artery either unilaterally (46 patients) or bilaterally (nine patients). Successful embolization was assessed angiographically and with helical CT follow-up examinations. Colonic ischemia was ruled out clinically or colonoscopically. Buttock claudication, and sexual dysfunction in men, were evaluated through a questionnaire.

RESULTS. Embolization of the internal iliac artery increased by 16% the percentage of patients for whom endovascular repair was suitable. After successful embolization in all patients, routine CT follow-up examinations after a mean time of 16.7 months showed no evidence of endoleaks related to retrograde perfusion via embolized internal iliac arteries. Nevertheless, in all patients who had undergone embolization, a primary endoleak was detected in 43.4% at the first postoperative CT examination. None of our patients had evidence of colonic ischemia. Clinical follow-up data of 46 patients were available. Of these patients, mild to severe new onset buttock claudication was found in 13 (36.1%) of 36 patients with unilateral, and in eight (80%) of 10 patients with bilateral, internal iliac artery embolization (p = 0.03). Five (25%) of 20 men had an erectile dysfunction after the procedure.

CONCLUSION. Embolization of the internal iliac artery is a safe and efficient procedure that increases the applicability for endovascular repair of aortoiliac aneurysms. However, buttock claudication and erectile dysfunction are a drawback in a substantial number of patients.

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