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2 . 2022

The necessity of internal iliac artery embolization in patients undergoing EVAR

Abstract

Aim. Endovascular aneurysm repair (EVAR) in patients with aortoiliac aneurysm sometimes requires internal iliac artery coverage to achieve a landing zone in the external iliac artery. In such cases there is a certain risk of type II endoleaks, so debate remains as to whether internal iliac artery embolization is required. The aim of this study was to compare EVAR with and without the internal iliac artery embolization prior to stent-graft coverage.             

Material and methods. We provided a retrospective analysis of 53 patients with aortoiliac aneurysm who underwent EVAR with stent-graft coverage of internal iliac artery. The patients were divided into 2 groups depending on the type of the procedure. The first group included patients who underwent EVAR with unilateral or bilateral internal iliac arteries coverage without prior embolization, the second group included patients who underwent EVAR with internal iliac arteries coverage and coil embolization.

Results. Primary technical success was achieved in all 53 patients (100%). All patients underwent a follow-up examination, which included a telephone questionnaire, CT-aortography 1 month post-operatively, then – annually. Buttock claudication occurred in 1 patient from the first group (3.4%) and in 5 patients from the second group (20.8%), although in 3 patients it resolved without intervention in under 6–12 months. 2 patients from the first group (6.9%) and 2 patients from the second group (8.3%) had lower extremities revascularization in postoperative period due to stent-graft thrombosis. No aneurysm growth or type II endoleak that required re-intervention was observed in any of these patients during follow-up, no signs of pelvic ischemia in either group. The total mortality in the first group was 3.4% (1 patient), there were no deaths in the second group.

Conclusion. Stent-graft coverage of internal iliac arteries without prior embolization during EVAR in patients with aortoiliac aneurysm is a safe and effective treatment with a low incidence of complications and re-interventions.

Keywords:aortoiliac aneurysm; endovascular aneurysm repair (EVAR); internal iliac artery coverage; internal iliac artery embolization; type II endoleak

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Polyakov R.S., Puretskiy M.V., Mardanyan G.V., Charchyan E.R., Kraynikov D.A., Karamian D.A., Vlasko G.S., Abugov S.A. The necessity of internal iliac artery embolization in patients undergoing EVAR. Clinical and Experimental Surgery. Petrovsky Journal. 2022; 10 (2): 81–7. DOI: https://doi.org/10.33029/2308-1198-2022-10-2-81-87  (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)
Вскрытие
Medicine today

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