Embolization of the Internal Iliac Artery Before EVAR: Is It Effective? Is It Safe? Which Technique Should Be Used?

Chun, Joo-Young; Mailli, Leto; Abbasi, Maaz Ali; Belli, Anna‐Maria; Gonsalves, Michael; Munneke, Graham; Ratnam, Lakshmi; Loftus, Ian; Morgan, Robert

doi:10.1007/s00270-013-0659-2

Cited by 40 publications

(29 citation statements)

References 31 publications

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“…15 In accordance with their results, we did not find a significant difference between ProxEmbX of unaffected IIA and DistEmbX of aneurysmatic IIA; however, in our study, another scenario in each group was reflected. Chun et al 15 reported pelvic ischaemia in 30% of patients with ProxEmbX and in 52% of patients with DistEmbX without statistic difference. In a recent systemic review of literature, Rayt et al 19 showed an overall incidence of buttock claudication and erectile dysfunction of 28% and 17%, respectively.…”

Section: Discussionsupporting

confidence: 92%

“…Several studies reported high technical success rates. 8,15,21,22,25 The number of coils used varies from patient to patient. Coil embolization may be complicated by compromising collateral vessels.…”

Section: Discussionmentioning

confidence: 99%

“…27,28 Bowel ischaemia, buttock claudication and sexual dysfunction are well-known side effects of IIA embolization. In 2013, Chun J et al 15 retrospectively analyzed data of 88 patients with unilateral and bilateral IIA embolization prior to EVAR. They further investigated symptoms of pelvic ischaemia in 47 patients.…”

Section: Discussionmentioning

confidence: 99%

“…13,14 A few studies have been published comparing proximal plug embolization vs distal embolization (DistEmbX) with coils and/or plugs. 11,12,15 However, no study has set a special focus on presence of distal aneurysmatic disease. The aim of this retrospective single centre study was to compare ProxEmbX strategies in unaffected IIAs with DistEmbX procedures performed in cases of aneurysmatic IIAs.…”

Section: Endovascular Aneurysm Repair (Evar) Is An Established Alternmentioning

confidence: 99%

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Proximal occlusion of unaffected internal iliac artery versus distal occlusion of aneurysmatic internal iliac artery prior to EVAR: a comparative evaluation of efficacy and clinical outcome

Dierks

Sauer

Wolfschmidt

et al. 2017

BJR

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Endovascular Aneurysm Repair (Evar) Is An Established Alternmentioning

confidence: 99%

See 2 more Smart Citations

Proximal occlusion of unaffected internal iliac artery versus distal occlusion of aneurysmatic internal iliac artery prior to EVAR: a comparative evaluation of efficacy and clinical outcome

Dierks

Sauer

Wolfschmidt

et al. 2017

BJR

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“…There is no general consensus regarding the use of either sequential or staged embolization of both internal iliac arteries, but in a majority of centres where both internal iliac arteries should be embolized, the staged strategy is most common [9] . Proximal embolization of the internal iliac artery is strongly advised to allow for collateral circulation [10] .…”

Section: Occlusion Of the Internal Iliac Arterymentioning

confidence: 99%

Endovascular treatment of aortoiliac aneurysms: From intentional occlusion of the internal iliac artery to branch iliac stent graft

Duvnjak¹

2016

WJR

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Approximately 20%-40% of patients with abdominal aortic aneurysms can have unilateral or bilateral iliac artery aneurysms and/or ectasia. This influences and compromises the distal sealing zone during endovascular aneurysm repair. There are a few endovascular techniques that are used to treat these types of aneurysms, including intentional occlusion/over-stenting of the internal iliac artery on one or both sides, the "bell-bottom" technique, and the more recent method of using an iliac branch stent graft. In some cases, other options include the "snorkel and sandwich" technique and hybrid interventions. Pelvic ischemia, represented as buttock claudication, has been reported in 16%-55% of cases; this is followed by impotence, which has been described in 10%-17% of cases following internal iliac artery occlusion. The bellbottom technique can be used for a common iliac artery up to 24 mm in diameter given that the largest diameter of the stent graft is 28 mm. There is a paucity of data and evidence regarding the "snorkel and sandwich" technique, which can be used in a few clinical scenarios. The hybrid intervention is comprised of a surgical operation, and is not purely endovascular. The newest branch stent graft technology enables preservation of the anterograde flow of important side branches. Technical success with the newest technique ranges from 85%-96.3%, and in some small series, technical success is 100%. Buttock claudication was reported in up to 4% of patients treated with a branch stent graft at 5-year follow-up. Mid-and short-term follow-up results showed branch patency of up to 88% during the 5-6-year period. Furthermore, branch graft occlusion is a potential complication, and it has been described to occur in 1.2%-11% of cases. Iliac branch stent graft placement represents a further development in endovascular medicine, and it has a high technical success rate without serious complications. 275March 28, 2016|Volume 8|Issue 3| WJR|www.wjgnet.com these include intentional occlusion/over-stenting of the internal iliac artery on one or both sides to create a distal landing zone in the external iliac artery, the "bell-bottom" technique, the "snorkel and sandwich" technique, and the more recent treatment of using an iliac branch stent graft. This review describes the pros and cons of these different endovascular techniques, while paying particular attention to the latest developments in branch stent graft technology.Duvnjak S. Endovascular treatment of aortoiliac aneurysms: From intentional occlusion of the internal iliac artery to branch iliac stent graft. World J Radiol 2016; 8(3): 275-280 Available from:

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Abdominal aortic aneurysms: pre- and post-procedural imaging

2018

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Abdominal aortic aneurysm (AAA) is a relatively common, potentially life-threatening disorder. Rupture of AAA is potentially catastrophic with high mortality. Intervention for AAA is indicated when the aneurysm reaches 5.0-5.5 cm or more, when symptomatic, or when increasing in size > 10 mm/year. AAA can be accurately assessed by cross-sectional imaging including computed tomography angiography and magnetic resonance angiography. Current options for intervention in AAA patients include open surgery and endovascular aneurysm repair (EVAR), with EVAR becoming more prevalent over time. Cross-sectional imaging plays a crucial role in AAA surveillance, pre-procedural assessment, and post-EVAR management. This paper will discuss the current role of imaging in the assessment of AAA patients prior to intervention, in evaluation of procedural complications, and in long-term follow-up of EVAR patients.

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Embolization of the Internal Iliac Artery Before EVAR: Is It Effective? Is It Safe? Which Technique Should Be Used?

Cited by 40 publications

References 31 publications

Proximal occlusion of unaffected internal iliac artery versus distal occlusion of aneurysmatic internal iliac artery prior to EVAR: a comparative evaluation of efficacy and clinical outcome

Proximal occlusion of unaffected internal iliac artery versus distal occlusion of aneurysmatic internal iliac artery prior to EVAR: a comparative evaluation of efficacy and clinical outcome

Endovascular treatment of aortoiliac aneurysms: From intentional occlusion of the internal iliac artery to branch iliac stent graft

Abdominal aortic aneurysms: pre- and post-procedural imaging

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