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Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Aortic Aneurysm Treatment

Background:

  • Internal iliac artery (IIA) coil embolization is frequently used with endovascular stent grafting (ESG) for abdominal aortic aneurysms (AAA).
  • Pelvic ischemia following IIA coil embolization is a reported complication, but findings on symptom severity are conflicting.
  • The impact of coil placement location within the IIA on pelvic ischemia outcomes is not well-defined.

Purpose of the Study:

  • To investigate the relationship between the location of coil placement in the internal iliac artery (IIA) and the occurrence of pelvic ischemia.
  • To clarify conflicting reports in the literature regarding pelvic ischemic symptoms after IIA coil embolization.
  • To determine optimal coil placement strategies to minimize post-procedural complications.

Main Methods:

  • A retrospective study of 20 patients with AAA who underwent ESG with unilateral IIA coil embolization between August 1997 and March 2002.
  • Patients were divided into two groups based on coil placement: proximal to the first IIA branch (8 patients) and distal to the first IIA branch (12 patients).
  • Symptoms of pelvic ischemia and mid-term outcomes were assessed and compared between the two groups.

Main Results:

  • Ten patients (50%) developed new pelvic ischemic symptoms post-procedure.
  • The incidence of pelvic ischemia was significantly higher in the distal IIA embolization group (75%) compared to the proximal group (13%) (P = .02).
  • Symptoms included buttock claudication and impotence; no colonic ischemia was observed. At 24-month follow-up, four patients remained significantly symptomatic.

Conclusions:

  • Distal coil placement in the internal iliac artery (IIA) is associated with a significantly higher incidence of pelvic ischemic symptoms.
  • Variations in coil placement strategy may explain discrepancies in previously published data on IIA embolization outcomes.
  • Performing IIA coil embolization as proximally as possible is recommended to preserve pelvic collateral circulation and reduce ischemic complications.