Challenging the Evidence for Pre-emptive Coil Embolisation of the Internal Iliac Artery during Endovascular Aneurysm Repair

Stokmans, R.A.; Willigendael, Edith M.; Teijink, Joep A.W.; Bosch, Jan A. Ten; Sambeek, Marc R.H.M. van; Cuypers, Ph.

doi:10.1016/j.ejvs.2012.12.001

Cited by 19 publications

(4 citation statements)

References 30 publications

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“…Also, if the patient had accepted open surgery, the internal iliac artery could have been grafted. Therefore, despite some claims that simple coverage without embolization does not increase the risk of secondary interventions, 16 there can still be cases in which HGA perfusion has to be sacrificed to obtain an adequate distal landing zone to prevent Type Ib and Type II endoleaks. As a result, we planned to sacrifice the right HGA to place a straight stent graft landing within the ipsilateral external iliac artery.…”

Section: Discussionmentioning

confidence: 99%

Hypogastric Artery Occlusion with Evoked Potentials Monitoring as Bailout Technique to Assess the Risk of Postoperative Spinal Cord Ischemia

D’Oria

Calvagna

Chiarandini

et al. 2019

Aorta

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A 65-year-old man, with previous open surgical repair of an infrarenal abdominal aortic, presented with acute complicated (paraplegia) Type B aortic dissection. He successfully underwent endovascular repair of the descending thoracic and abdominal aorta. Following the procedure, the neurological manifestations resolved. As he had a concomitant aneurysm of the right hypogastric artery (HGA), we executed a 10-minute balloon occlusion of this artery with evoked potential measurements to assess the risk of spinal cord ischemia after exclusion of the right HGA. The examination was interpreted as negative, and we proceeded with coil embolization of the right HGA and subsequent placement of an endograft landing distally within the external iliac artery. The postoperative course was totally uneventful, and the patient was discharged home 4 days after the operation. Computed tomography angiography follow-up at 1, 6, 12 and 24 months showed patency of all endografts without any signs of endoleak and effective remodeling of the descending thoracic aorta with volume reduction of the false lumen.

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Section: Discussionmentioning

confidence: 99%

Hypogastric Artery Occlusion with Evoked Potentials Monitoring as Bailout Technique to Assess the Risk of Postoperative Spinal Cord Ischemia

D’Oria

Calvagna

Chiarandini

et al. 2019

Aorta

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“…The most frequent adverse effect of acute pelvic ischaemia due to IOHA is buttock claudication (BC), and its rare but severe complications include skin necrosis, colon ischaemia, and paraplegia. [1,2]…”

Section: Introductionmentioning

confidence: 99%

“…Although BC is not fatal and is usually resolved in the chronic state, its incidence is high and the post-EVAR quality of life is impaired. [2] Interestingly, the incidence varies greatly in the literature, from 22% to 55%. [1–7] This variation may be due to difficulties in the evaluation of BC, such as poor clinical assessment criteria, lack of prospective control data, and possible confusion with common mobility-limiting conditions in the target population.…”

Section: Introductionmentioning

confidence: 99%

“…[1–7] This variation may be due to difficulties in the evaluation of BC, such as poor clinical assessment criteria, lack of prospective control data, and possible confusion with common mobility-limiting conditions in the target population. [2] Complaints of BC are sometimes overlooked because of its benign and non-fatal nature; therefore, the reported incidence of BC may be greater when detailed information regarding BC is specifically gathered from patients who underwent IOHA, such as by email or telephone interviews. [6] If evaluated accurately, BC may be considered a good indicator of tolerance to pelvic ischaemia.…”

Section: Introductionmentioning

confidence: 99%

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Changes in blood flow distribution after hypogastric artery embolization and the ischaemic tolerance of the pelvic circulation

Nitta

Hoshina²,

Isaji³

2019

Medicine

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This study aimed to compare the pelvic cavity vasculature before and after the interventional occlusion of a hypogastric artery (IOHA) and to reveal the protective mechanism of the collateral vessels against pelvic ischaemia. Sixty-nine patients with abdominal aortic or aortoiliac aneurysms who underwent endovascular aneurysm repair accompanied with IOHA were retrospectively analysed. Patients were divided into those who complained of buttock claudication (BC) group and asymptomatic patients (non-BC group). Two analyses were performed. In Study 1, the factors associated with postoperative BC were evaluated in patients who underwent IOHA using only 0.035 Tornade embolization coils. In Study 2, the pelvic arterial volume (PAV) was assessed in patients with both pre- and postoperative multidetector computed tomography images. PAV was calculated by subtracting the aortoiliac artery volume from the total PAV. The PAV ratio was defined as the postoperative PAV divided by preoperative PAV and represented collateral development in the pelvis. In Study 1, BC occurred in 16 patients (BC group) and did not occur in 25 patients (non-BC group). Significantly more coils were used in the BC group than in the non-BC group (8.6 ± 1.0 vs 5.6 ± 0.83, P = .013). Study 2 had 24 patients in the BC group and 31 patients in the non-BC group. The PAV ratio was significantly higher in the BC group than in the non-BC group (0.93 ± 0.05 vs 0.62 ± 0.04, P <.0001). The use of more coils in IOHA is associated with BC. In addition, volumetric analysis revealed that less collateral vessel development occurred in the non-BC group than in the BC group, which might reflect a potential reservation capacity of non-BC patients for acute pelvic ischaemia.

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In Patients Who Require Hypogastric Artery Coverage to Treat an AAA with EVAR, Does Preservation Improve Outcomes When Compared to Exclusion of the Vessel?

Iranmanesh

Woo

2017

Difficult Decisions in Surgery: An Evidence-Based Approach

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Challenging the Evidence for Pre-emptive Coil Embolisation of the Internal Iliac Artery during Endovascular Aneurysm Repair

Cited by 19 publications

References 30 publications

Hypogastric Artery Occlusion with Evoked Potentials Monitoring as Bailout Technique to Assess the Risk of Postoperative Spinal Cord Ischemia

Hypogastric Artery Occlusion with Evoked Potentials Monitoring as Bailout Technique to Assess the Risk of Postoperative Spinal Cord Ischemia

Changes in blood flow distribution after hypogastric artery embolization and the ischaemic tolerance of the pelvic circulation

In Patients Who Require Hypogastric Artery Coverage to Treat an AAA with EVAR, Does Preservation Improve Outcomes When Compared to Exclusion of the Vessel?

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