title: How safe is internal iliac artery embolisation prior to EVAR? A 10-year retrospective review.
abstract: OBJECTIVE
  Internal iliac artery (IIA) embolisation is commonly performed prior to endovascular aneurysm repair (EVAR) of aortoiliac aneurysms to prevent type 2 endoleaks via the internal iliac arteries. The safety of this procedure is controversial due to the high incidence of pelvic ischaemic complications.
  
  
  METHODS
  We undertook a retrospective review of all patients undergoing IIA embolisation before EVAR from 2002 to 2012, to determine incidence of, and factors associated with pelvic ischaemia.
  
  
  RESULTS
  Eight of 25 patients (32 %) experienced new-onset ischaemia, including erectile dysfunction (4 %), and buttock claudication (28 %) that persisted >6 months in only four patients (16 %). Both bilateral IIA embolisation and a shorter time interval to EVAR correlate with increased risk (p = 0.006 and p = 0.044). No co-morbidities or demographic factors were predictive.
  
  
  CONCLUSIONS
  We conclude that IIA embolisation remains a beneficial procedure, however, to minimise the risk of buttock claudication we advise against both bilateral IIA embolisation and short time intervals between embolisation and subsequent EVAR.
authors.affiliation: Department of Academic Radiology, Beaumont Hospital Dublin, Dublin, Ireland. mcgarryj@tcd.ie.
authors.forename: J G
authors.initials: JG
authors.lastname: McGarry
authors.affiliation: Department of Academic Radiology, Beaumont Hospital Dublin, Dublin, Ireland.
authors.forename: A O
authors.initials: AO
authors.lastname: Alenezi
authors.affiliation: Department of Academic Radiology, Beaumont Hospital Dublin, Dublin, Ireland.
authors.forename: F P
authors.initials: FP
authors.lastname: McGrath
authors.affiliation: Department of Academic Radiology, Beaumont Hospital Dublin, Dublin, Ireland.
authors.forename: M F
authors.initials: MF
authors.lastname: Given
authors.affiliation: Department of Academic Radiology, Beaumont Hospital Dublin, Dublin, Ireland.
authors.forename: A N
authors.initials: AN
authors.lastname: Keeling
authors.affiliation: Department of Surgery, Beaumont Hospital Dublin, Dublin, Ireland.
authors.forename: D S
authors.initials: DS
authors.lastname: Moneley
authors.affiliation: Department of Surgery, Beaumont Hospital Dublin, Dublin, Ireland.|Faculty of Radiology, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: A L
authors.initials: AL
authors.lastname: Leahy
authors.affiliation: Department of Academic Radiology, Beaumont Hospital Dublin, Dublin, Ireland.|Faculty of Radiology, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: M J
authors.initials: MJ
authors.lastname: Lee
mesh_terms: D000368:Aged; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D017543:Iliac Aneurysm / Q000601:surgery*; D007083:Iliac Artery / Q000473:pathology / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aortoiliac aneurysm; Buttock claudication; EVAR; Embolisation; Internal iliac artery; Pelvic ischemia