title: Proximal occlusion of unaffected internal iliac artery versus distal occlusion of aneurysmatic internal iliac artery prior to EVAR: a comparative evaluation of efficacy and clinical outcome.
abstract: OBJECTIVE
  Occlusion of the internal iliac artery (IIA) may be necessary prior to endovascular aneurysm repair (EVAR) to prevent endoleak Type II. We compared efficacy and clinical outcome after proximal occlusion of an unaffected IIA (ProxEmbx) using an Amplatzer vascular plug (AVP) I vs distal occlusion of aneurysmatic IIA with coils and plugs (DistEmbx).
  
  
  METHODS
  Between 2009 and 2012, 22 patients underwent EVAR. In 9 patients with unaffected IIA, occlusion was performed by a single AVP. In 13 patients with aneurysmatic IIA, more distal embolization (DistEmbX) was conducted by using several coils and additional AVPs. Retrospectively, technical success, clinical outcome and complications were evaluated.
  
  
  RESULTS
  Embolization of the IIA was successful in all patients. Three patients with more DistEmbX of aneurysmatic IIAs suffered from new onset of sexual dysfunction after occlusion without statistically significant difference (p > 0.05). Transient buttock claudication was observed in three patients in each group. Bowel ischaemia did not occur. The procedure time (p = 0.013) and fluoroscopy time (p = 0.038) was significantly lower in the ProxEmbx group than in the DistEmbx group.
  
  
  CONCLUSIONS
  Proximal occlusion of an unaffected IIA and more distal occlusion of an aneurysmatic IIA prior to EVAR had the same technical and clinical outcome. However, proximal plug embolization of an unaffected IIA prior to EVAR was associated with shorter procedure and fluoroscopy time in comparison with more DistEmbX of aneurysmatic IIAs. Advances in knowledge: Proximal embolization of unaffected IIA and DistEmbX of aneurysmatic IIA before EVAR are both effective in preventing Type II endoleaks and have the same technical and clinical outcome.
authors.affiliation: 1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Dierks
authors.affiliation: 1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Sauer
authors.affiliation: 1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Wolfschmidt
authors.affiliation: 1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany.
authors.forename: Nicole
authors.initials: N
authors.lastname: Hassold
authors.affiliation: 2 Department of General, Visceral, Vascular and Paediatric Surgery, University of Wuerzburg, Würzburg, Germany.
authors.forename: Richard
authors.initials: R
authors.lastname: Kellersmann
authors.affiliation: 1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany.
authors.forename: Thorsten A
authors.initials: TA
authors.lastname: Bley
authors.affiliation: 1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany.
authors.forename: Ralph
authors.initials: R
authors.lastname: Kickuth
mesh_terms: D000368:Aged; D000792:Angiography; D019917:Blood Vessel Prosthesis Implantation; D057867:Endoleak / Q000517:prevention & control*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D017543:Iliac Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D015641:Radiography, Interventional; D055989:Septal Occluder Device; D016896:Treatment Outcome