title: Buttock claudication and erectile dysfunction after internal iliac artery embolization in patients prior to endovascular aortic aneurysm repair.
abstract: Coil embolization of the internal iliac artery (IIA) is used to extend the application of endovascular aneurysm repair (EVAR) in cases of challenging iliac anatomy. Pelvic ischemia is a complication of the technique, but reports vary as to the rate and severity. This study reports our experience with IIA embolization and compares the results to those of other published series. The vascular unit database of the Leicester Royal Infirmary was used to identify patients who had undergone IIA coil embolization prior to EVAR. Data were collected from hospital case notes and by telephone interviews. Thirty-eight patients were identified; 29 of these were contactable by telephone. A literature search was performed for other studies of IIA embolization and the results were pooled. In this series buttock claudication occurred in 55% (16 of 29 patients) overall: in 52% of unilateral embolizations (11 of 21) and 63% of bilateral embolizations (5 of 8). New erectile dysfunction occurred in 46% (6 of 13 patients) overall: in 38% of unilateral embolizations (3 of 8) and 60% of bilateral embolizations (3 of 5). The literature review identified 18 relevant studies. The results were pooled with our results, to give 634 patients in total. Buttock claudication occurred in 28% overall (178 of 634 patients): in 31% of unilateral embolizations (99 of 322) and 35% of bilateral embolizations (34 of 98) (p = 0.46, Fisher's exact test). New erectile dysfunction occurred in 17% overall (27 of 159 patients): in 17% of unilateral embolizations (16 of 97) and 24% of bilateral embolizations (9 of 38) (p = 0.33). We conclude that buttock claudication and erectile dysfunction are frequent complications of IIA embolization and patients should be counseled accordingly.
authors.affiliation: Division of Cardiovascular Sciences, Vascular Surgery Research Group, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester, LE2 7LX, UK. hsrayt@hotmail.com
authors.forename: H S
authors.initials: HS
authors.lastname: Rayt
authors.forename: M J
authors.initials: MJ
authors.lastname: Bown
authors.forename: K V
authors.initials: KV
authors.lastname: Lambert
authors.forename: N G
authors.initials: NG
authors.lastname: Fishwick
authors.forename: M J
authors.initials: MJ
authors.lastname: McCarthy
authors.forename: N J M
authors.initials: NJ
authors.lastname: London
authors.forename: R D
authors.initials: RD
authors.lastname: Sayers
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000379:methods*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002081:Buttocks / Q000098:blood supply; D015331:Cohort Studies; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D007172:Erectile Dysfunction / Q000453:epidemiology / Q000209:etiology*; D005500:Follow-Up Studies; D006801:Humans; D017543:Iliac Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D015994:Incidence; D007511:Ischemia / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome