Persistent Buttock Claudication after Endovascular Abdominal Aortic Aneurysm Repair

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aortoiliac Disease

Background:

• Endovascular aneurysm repair (EVAR) is common for aortoiliac aneurysms.
• Internal iliac artery (IIA) embolization can cause buttock claudication.
• Pelvic inflow preservation is crucial for preventing ischemic complications.

Observation:

• A 71-year-old male experienced disabling right buttock claudication post-right IIA coil embolization.
• CT angiography showed extensive aortoiliac calcifications and thrombus.
• Symptoms persisted despite contralateral IIA patency and collateral flow.

Findings:

• The patient underwent successful open infrarenal abdominal aortic aneurysm repair with stent-graft removal.
• Concomitant revascularization of the right IIA was performed.
• The patient remained asymptomatic at 30-month follow-up.

Implications:

• Open surgery can be a successful solution for buttock claudication after IIA embolization.
• Preserving pelvic inflow is vital, especially in high-risk patients with complex atheroma.
• Consideration of open repair is important for managing complications of EVAR adjuncts.