title: How safe is bilateral internal iliac artery embolization prior to EVAR?
abstract: OBJECTIVE
  To assess the outcomes of patients after bilateral internal iliac artery (IIA) embolization prior to endovascular aneurysm repair (EVAR).
  
  
  METHODS
  Thirty-nine patients (age range 55-88 years, mean 72.5 years; 2 women) underwent IIA embolization/occlusion before EVAR. There were 28 patients with aorto-biiliac aneurysms and 6 with bilateral common iliac artery (CIA) aneurysms. Five patients with unilateral CIA aneurysms had previous surgical ligation of the contralateral IIA or inadvertent covering by the stent-graft of the contralateral IIA origin. Outcomes were assessed by clinical follow-up.
  
  
  RESULTS
  Severe ischemic complications were limited to spinal cord ischemia in 1 patient (3%) who developed paraparesis following EVAR. No other severe ischemic complications such as buttock necrosis, or bowel or bladder ischemia, occurred. Buttock and/or thigh claudication occurred in 12 patients (31%) and persisted beyond 1 year in 3 patients (9%). Sexual dysfunction occurred in 2 patients (5%). Patients who underwent simultaneous embolization had a 25% (3/12) ischemic complication rate versus 41% (11/27) in those with sequential embolization (p = 0.48). Embolization limited to the main trunk of the IIA resulted in a significantly reduced ischemic complication rate of 16% (3/19) versus 55% (11/20) of patients who had a more distal embolization of the IIA (p = 0.019, Fisher's exact test).
  
  
  CONCLUSIONS
  Severe complications after bilateral IIA embolization are uncommon. Although buttock/thigh claudication occurs in around 30% of patients soon after the procedure, this resolves in the majority after 1 year. There is no obvious benefit for sequential versus simultaneous IIA embolization in our series. Occlusion of the proximal IIA trunk is associated with reduced complications compared with occlusion of the distal IIA.
authors.affiliation: Department of Radiology, St. George's Hospital, Blackshaw Road, Tooting, London, SW17 OQT, UK. Robert.Morgan@stgeorges.nhs.uk
authors.forename: M J
authors.initials: MJ
authors.lastname: Bratby
authors.forename: G M
authors.initials: GM
authors.lastname: Munneke
authors.forename: A-M
authors.initials: AM
authors.lastname: Belli
authors.forename: T M
authors.initials: TM
authors.lastname: Loosemore
authors.forename: I
authors.initials: I
authors.lastname: Loftus
authors.forename: M M
authors.initials: MM
authors.lastname: Thompson
authors.forename: R A
authors.initials: RA
authors.lastname: Morgan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D017543:Iliac Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015641:Radiography, Interventional; D015607:Stents; D016896:Treatment Outcome