How safe is bilateral internal iliac artery embolization prior to EVAR?
| Autor: | G. M. Munneke, Ian M. Loftus, Matt M. Thompson, Tom Loosemore, A.-M. Belli, R. A. Morgan, M. J. Bratby |
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| Rok vydání: | 2007 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Arterial Occlusive Diseases Radiography Interventional Endovascular aneurysm repair Aortic aneurysm Blood Vessel Prosthesis Implantation Postoperative Complications medicine.artery Occlusion Medicine Humans Radiology Nuclear Medicine and imaging Embolization Aged Aged 80 and over business.industry Angiography Middle Aged medicine.disease Internal iliac artery Common iliac artery Embolization Therapeutic Abdominal aortic aneurysm Surgery Treatment Outcome Iliac Aneurysm Female Stents Radiology medicine.symptom Cardiology and Cardiovascular Medicine business Claudication Aortic Aneurysm Abdominal |
| Zdroj: | Cardiovascular and interventional radiology. 31(2) |
| ISSN: | 1432-086X |
| Popis: | To assess the outcomes of patients after bilateral internal iliac artery (IIA) embolization prior to endovascular aneurysm repair (EVAR). 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. 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). 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. |
| Databáze: | OpenAIRE |
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