Coil embolization of iliac artery aneurysms developing after abdominal aortic aneurysm repair with a conventional bifurcated graft.
OBJECTIVE
To evaluate the efficacy of embolizing iliac artery aneurysms (IAAs) developing after abdominal aortic aneurysm (AAA) repair.


METHODS
The records of 6 patients (5 men; mean age 79 years, range 61-87) with unilateral (n=3) or bilateral (n=3) IAAs that had developed after AAA repair were reviewed. In all patients, the limbs of the bifurcated graft were anastomosed end-to-end or end-to-side with the external iliac arteries during AAA repair. Before embolization, superior mesenteric artery (SMA) arteriography was done in all patients to evaluate collateral pathways to the inferior mesenteric artery (IMA).


RESULTS
The unilateral IAAs were treated by proximal and distal embolization. In 2 patients with bilateral IAAs, SMA angiography showed sufficient collateral flow to the IMA, so the aneurysms were treated by proximal embolization and packing. In the other bilateral IAA case, the left 6-cm IAA was treated by proximal and distal embolization, while the contralateral 3-cm IAA was not embolized because angiography demonstrated inadequate collateral flow to the IMA, indicating a possible risk of colon ischemia if both IAAs were embolized. Immediate postprocedural angiography in all patients showed complete exclusion of the IAAs. Mild buttock claudication occurred in 1 patient. There were no episodes of rupture over a mean 46-month follow-up.


CONCLUSIONS
Embolization is a safe and effective alternative to open surgery for the treatment of IAAs that develop after AAA repair. However, before embolization, angiographic evaluation of collateral pathways to the IMA is essential to reduce the risk of colon ischemia.
Sakamoto
Ichiro
I
Department of Radiology, Nagasaki University School of Medicine, Nagasaki, Japan. ichiro-s@net.nagasaki-u.ac.jp
Mori
Masakazu
M
Nishida
Akifumi
A
Fukushima
Aya
A
Sueyoshi
Eijun
E
Hazama
Shiro
S
Eishi
Kiyoyuki
K
Hayashi
Kuniaki
K
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D000792:Angiography; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017543:Iliac Aneurysm / Q000209:etiology / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D015996:Survival Rate; D016896:Treatment Outcome