Adverse consequences of internal iliac artery occlusion during endovascular repair of abdominal aortic aneurysms

Objective: Embolization of the internal iliac artery (IIA) may be performed during endovascular abdominal aortic aneurysm (AAA) repair if aneurysmal d isease of the common iliac artery precludes graft placement proximal to the IIA orifice. The IIA may also be unintentionally occluded because of iliac trauma or coverage by the endograft. The purpose of this study was to dete rmine the incidence, etiology, and consequences of PLA occlusion during end oluminal AAA repair. Methods: Over 2 years, 96 patients have undergone endoluminal AAA repair. T he details of the operative procedure, reasons for IIA. occlusion, perioper ative complications, and clinical follow-up were recorded. Results: The IIA was intentionally occluded in 15 patients (16%) to treat 1 3 common iliac artery aneurysms, one IIA aneurysm, and one external iliac a rtery aneurysm. The IIA was unintentionally occluded in 9 patients (9%), re sulting from traumatic iliac dissection in 5 patients and coverage of the I IA by the endograft in the remaining 4 patients. Three patients had colon i schemia. One patient with a unilateral IIA occlusion had sigmoid infarction necessitating resection. The other two patients underwent intentional occl usion of one IIA followed by unintentional occlusion of the contralateral I IA because of a traumatic iliac dissection. Both had postoperative abdomina l pain and distention; rectosigmoid ischemia was revealed through colonosco py. Conservative treatment with bowel rest and broad-spectrum antibiotics w as successful in both cases. Nondisabling hip and buttock claudication occu rred in seven patients (32%) at I month but resolved by 6 months in three o f these patients. Conclusion: Embolization of the IIA for iliac aneurysmal disease and uninte ntional IIA occlusion due to trauma or graft coverage occurs in a considera ble number of patients undergoing endoluminal AAA repair. Most patients wit h unilateral occlusion do not experience colon ischemia or disabling claudi cation. Therefore, unilateral embolization of the IIA is well tolerated and allows for the endoluminal treatment of patients with both an AAA and an i liac artery aneurysm, thereby expanding the number of patients who can be m anaged with an endovascular approach. Although acute, bilateral IIA. occlus ions should be avoided, significant consequences were not observed in our s mall series of patients.