Efficacy of the Preloading Coil-In-Plug Method for Internal Iliac Artery Embolization

During endovascular aneurysm repair (EVAR), embolization of the internal iliac artery (IIA) is sometimes necessary. The preloading coil-in-plug (P-CIP) technique allows high-density embolization within a confined area. This retrospective study at our institution evaluated the efficacy of the P-CIP technique and compared it with conventional coil embolization (CE).

Between January 2015 and December 2023, 201 patients underwent EVAR. Seventy-three patients underwent IIA trunk embolization. Patients who underwent embolization using only an Amplatzer vascular plug (AVP) or P-CIP using an AVP2 were excluded. Fifty-six patients (mean age, 76.7 years; 11 female patients) were categorized into the P-CIP (25 patients) and CE (31 patients) groups.

The embolization site vessel diameter (8.08 ± 1.9 mm vs 8.01 ± 2.2 mm; P = 0.85), procedure time (36.4 ± 3.1 minutes vs 34.0 ± 3.1 minutes; P = 0.45) and incidence of type 2 endoleaks (0 [0%] vs. 1 [3.2%]; P = 0.27) of both groups were not significantly different. Compared to the CE group, the P-CIP group required fewer coils (3.36 ± 0.26 vs 4.30 ± 0.24; P = 0.037) and had a significantly higher complete occlusion rate (19 [76.0%] vs 10 [32.3%]; P < 0.002). Compared to the CE group, the P-CIP group had a significantly smaller embolization range (20.1 ± 5.46 mm vs. 31.7 ± 7.2 mm; P < 0.001); however, the buttock claudication incidence was not significantly different (13 [52.0%] vs 13 [41.9%]; P = 0.45). All patients experienced full recovery of buttock claudication within 1 year postoperatively.

The P-CIP technique enabled effective and reliable embolization of the IIA trunk and demonstrated advantages over conventional CE.