title: Technical and outcome considerations of endovascular treatment for internal iliac artery aneurysms.
abstract: OBJECTIVE
  This study was designed to analyze the outcomes of endovascular treatment for internal iliac artery aneurysm (IIAA) at mid-term follow-up.
  
  
  METHODS
  We retrospectively analyzed 33 patients (28 males, mean age 77.4 years) who underwent endovascular treatment of 35 IIAAs (mean diameter 39.8 mm) from 2002 to 2012. We attempted to completely and selectively embolize all distal branches with permanent embolic materials, followed by proximal controls either by stent-graft placement (type 1) or coil embolization (type 2).
  
  
  RESULTS
  Procedural success rate was 97.1% (n = 34). Complete permanent distal branches embolization was achieved in 27 (79.4%), type 1 in 24 (70.6%), and type 2 in 10 (29.4%) cases. During mean follow-up period of 29.1 months (range, 1.2-92.8), no IIAA-related mortality and stent/stent-graft related complications occurred. Pelvic ischemia occurred and resolved in 8 (25%) patients. Among 32 cases followed by CT, the aneurysm diameter was stable in 18 (56.3%), shrank in 11 (34.4%), and enlarged in 3 (9.4%) cases. In 22 assessed by contrast-enhanced CT, secondary endoleak occurred in 3 (13.6%) cases and 2 required secondary interventions (2/32, 6.3%). Type 1 procedure tends to have better mid-term outcomes. Incomplete permanent distal branches embolization was associated with enlargement and secondary intervention (p = 0.007 and p = 0.042, respectively). The secondary intervention-free rate at 3 years in the complete and incomplete distal embolization group was 100 and 83.3%, respectively (p = 0.128).
  
  
  CONCLUSIONS
  Endovascular treatment for IIAA is feasible and safe. Complete permanent distal branches embolization is important to achieve satisfactory mid-term outcomes.
authors.affiliation: Center for Endovascular Therapy, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan, akhmadumuradi@gmail.com.
authors.forename: Akhmadu
authors.initials: A
authors.lastname: Muradi
authors.forename: Masato
authors.initials: M
authors.lastname: Yamaguchi
authors.forename: Takuya
authors.initials: T
authors.lastname: Okada
authors.forename: Yoshikatsu
authors.initials: Y
authors.lastname: Nomura
authors.forename: Koji
authors.initials: K
authors.lastname: Idoguchi
authors.forename: Eisuke
authors.initials: E
authors.lastname: Ueshima
authors.forename: Noriaki
authors.initials: N
authors.lastname: Sakamoto
authors.forename: Ryota
authors.initials: R
authors.lastname: Kawasaki
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Okita
authors.forename: Koji
authors.initials: K
authors.lastname: Sugimoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D057867:Endoleak / Q000000981:diagnostic imaging / Q000453:epidemiology; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017543:Iliac Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome