Clinical outcomes after internal iliac artery embolization prior to endovascular aortic aneurysm repair

The success of endovascular aortic aneurysm repair (EVAR) is highly dependent on the anatomical features of the aneurysm. In order to prevent type II endoleaks from the internal iliac artery (IIA), embolization of one or both IIAs may be required.

We performed a retrospective study of a prospectively gathered database of 100 patients who underwent EVAR at our institution. The case notes were examined, and patients were interviewed by telephone and specifically asked about symptoms of pelvic ischemia that they had experienced since undergoing EVAR.

We identified 42 (42 %) patients who had undergone coil embolization of one or both IIAs in preparation for EVAR. The mean time from surgery to the follow-up telephone interview was 21.5 months. Buttock claudication occurred in 10 (26 %) of 38 patients. Sexual dysfunction occurred in 13 of 36 male patients (36 %). Age was associated with buttock claudication and sexual dysfunction.

Based on our experience, IIA embolization prior to EVAR is not a benign procedure. It can lead to numerous effects associated with pelvic ischemia, such as buttock claudication and sexual dysfunction. It is necessary to preserve both internal iliac arteries if possible, especially in young patients.