Hypogastric Artery Coil Embolization prior to Endoluminal Repair of Aneurysms and Fistulas: Buttock Claudication, a Recognized but Possibly Preventable Complication

When Should the Internal Iliac Arteries be Preserved in Patients Undergoing Endovascular or Open Repair of Aortoiliac Aneurysms?

“…Although coils are always placed proximally in the IIA, they can embolize distally into secondary branches and interrupt the pelvic collateral circulation. Although we did not analyze the exact location of coils in the IIAs and its relation to morbidity, Cynamon et al 18 have recently published their experience with 13 patients who developed buttock claudication after IIA coil embolization. They reported a substantial difference in the incidence of buttock claudication when coils were placed in the proximal IIA (10%) as opposed to its distal branches (55%).…”

Outcome after concomitant unilateral embolization of the internal iliac artery and contralateral external-to-internal iliac artery bypass grafting during endovascular aneurysm repair

“…Previous reports have demonstrated that ischemic complications occurred in more than half of patients after distal embolization of IIA compared with 10% to 16% of cases after proximal interruption. 6,8,9 However, it is often necessary to occlude its distal branches, especially in cases with associated IIA aneurysms. Indeed, 13 patients (59%) had IIA aneurysms in our series, and distal embolization was required in 11 cases (50%).…”

“…Although unilateral occlusion of IIA followed by EVAR is a relatively safe technique, [5][6][7] bilateral IIA embolization can lead to severe ischemic complications such as ischemic colitis or neurologic deficit. 8,9 Thus, in patients in whom stent graft limbs need to be extended into the bilateral EIAs, various attempts have been made to revascularize at least unilateral hypogastric flow to preserve pelvic perfusion.…”

Stent graft implantation combined with coil embolization and external-internal iliac artery bypass surgery: Report of a case

“…6 In the event of reduced anterograde blood fl ow associated with internal iliac artery occlusion, postoperative complications may occur, including gluteal claudication (incidence, 26%-41%), impotence (4%-12%), and intestinal ischemia (4%-12%). [7][8][9][10][11][12] The incidence of gluteal claudication is said to depend on the condition of the internal iliac artery occlusion. The incidence is reported to be 10%-33% for coil embolization in the main body of the artery and 55%-100% for coil embolization in the distal region or branches of the artery.…”