Internal iliac artery embolization in the stent-graft treatment of aortoiliac aneurysms: Analysis of outcomes and complications

PURPOSE: To analyze the complications of internal iliac artery (IIA) emboli zation in conjunction with stent-graft treatment of aortoiliac aneurysms. MATERIALS AND METHODS: Seventy-one patients with aortoiliac (n = 47) or ili ac (n = 24) aneurysms were treated with endoluminal placement of stent-graf ts. Thirty-two patients (31 men, one woman; mean age, 73 years; range, 56-8 8 years) had embolization or occlusion of one (n = 27) or both (n = 5) IIAs , Status of the IIAs and the collateral circulation was assessed by retrosp ective review of angiographic images. Follow-up consisted of a standardized patient questionnaire and review of radiologic and medical records. RESULTS: The mean follow-up time was 35 months (range, 5-64 months). Eleven of the 47 patients with abdominal aortic aneurysms (AAA) (23%,) and 19 of the 24 patients with iliac aneurysms (79%) required IIA embolization. One p atient with AAA and another with iliac aneurysm had unintentional occlusion of an IIA by extension of the stent-graft over their origins, A total of s even patients had bilateral occlusion of the IIAs after the procedure. Addi tionally, the inferior mesenteric arteries (IMAs) of two other patients wit h AAA were also embolized, In six patients, all three vessels were occluded after placement of the stent-grafts. Symptoms were reported in nine of the 20 (45%) patients with iliac aneurysms and in three of the 12 (25%) patien ts with AAA, Symptoms consisted of buttock claudication (nine of 32, 28%), new sexual dysfunction (two of 16, 12%), and transient urinary retention (3 %). Seven of the claudicants had resolution of symptoms after a mean interv al of 14 months (range, 1-36 months). There were no instances of bowel isch emia, neurologic sequelae, or buttock. necrosis related to these procedures , CONCLUSION: Embolization of the IIA is associated with symptoms in a signif icant number of patients. While symptoms are transient in most patients, th ey can be problematic. Efforts should be made to preserve the pelvic circul ation if possible.