Internal iliac artery embolization before endovascular repair of abdominalaortic aneurysms: Frequency, efficacy, and clinical results

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 pr eprocedural embolization of the internal iliac artery either unilaterally ( 46 patients) or bilaterally (nine patients). Successful embolization was as sessed angiographically and with helical CT follow-up examinations. Colonic ischemia was ruled out clinically or colonoscopically. Buttock claudicatio n, and sexual dysfunction in men, were evaluated through a questionnaire. RESULTS. Embolization of the internal iliac artery increased by 16% the per centage of patients for whom endovascular repair was suitable. After succes sful embolization in all patients, routine CT follow-up examinations after a mean time of 16.7 months showed no evidence of endoleaks related to retro grade perfusion via embolized internal iliac arteries. Nevertheless, in all patients who had undergone embolization, a primary endoleak was detected i n 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 = 0.0 3). Five (25%) of 20 men had an erectile dysfunction after the procedure. CONCLUSION. Embolization of the internal iliac artery is a safe and efficie nt procedure that increases the applicability for endovascular repair of ao rtoiliac aneurysms. However, buttock claudication and erectile dysfunction are a drawback in a substantial number of patients.