title: Internal iliac artery embolization before endovascular repair of abdominal aortic aneurysms: frequency, efficacy, and clinical results.
abstract: OBJECTIVE
  The aim of our study was to assess the frequency, efficacy, and incidence of adverse effects of internal iliac artery embolization.
  
  
  METHODS
  Of 343 patients examined for stent-graft repair, 147 were suitable for endovascular treatment. Fifty-five patients underwent preprocedural embolization of the internal iliac artery either unilaterally (46 patients) or bilaterally (nine patients). Successful embolization was assessed angiographically and with helical CT follow-up examinations. Colonic ischemia was ruled out clinically or colonoscopically. Buttock claudication, and sexual dysfunction in men, were evaluated through a questionnaire.
  
  
  RESULTS
  Embolization of the internal iliac artery increased by 16% the percentage of patients for whom endovascular repair was suitable. After successful embolization in all patients, routine CT follow-up examinations after a mean time of 16.7 months showed no evidence of endoleaks related to retrograde perfusion via embolized internal iliac arteries. Nevertheless, in all patients who had undergone embolization, a primary endoleak was detected in 43.4% at the first postoperative CT examination. None of our patients had evidence of colonic ischemia. Clinical follow-up data of 46 patients were available. Of these patients, mild to severe new onset buttock claudication was found in 13 (36.1%) of 36 patients with unilateral, and in eight (80%) of 10 patients with bilateral, internal iliac artery embolization (p = 0.03). Five (25%) of 20 men had an erectile dysfunction after the procedure.
  
  
  CONCLUSIONS
  Embolization of the internal iliac artery is a safe and efficient procedure that increases the applicability for endovascular repair of aortoiliac aneurysms. However, buttock claudication and erectile dysfunction are a drawback in a substantial number of patients.
authors.affiliation: Department of Angiography and Interventional Radiology, AKH-University Clinics, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Schoder
authors.forename: L
authors.initials: L
authors.lastname: Zaunbauer
authors.forename: T
authors.initials: T
authors.lastname: Hölzenbein
authors.forename: D
authors.initials: D
authors.lastname: Fleischmann
authors.forename: M
authors.initials: M
authors.lastname: Cejna
authors.forename: G
authors.initials: G
authors.lastname: Kretschmer
authors.forename: S
authors.initials: S
authors.lastname: Thurnher
authors.forename: J
authors.initials: J
authors.lastname: Lammer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation; D002081:Buttocks / Q000098:blood supply; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D007383:Intermittent Claudication / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011300:Preoperative Care; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome