TY - JOUR
T1 - Challenging the Evidence for Pre-emptive Coil Embolisation of the Internal Iliac Artery during Endovascular Aneurysm Repair
AU - Stokmans, R. A.
AU - Willigendael, Edith M.
AU - Teijink, J. A. W.
AU - Ten Bosch, Jan A.
AU - Van Sambeek, Marc R. H. M.
AU - Cuypers, Ph. W. M.
PY - 2013/3
Y1 - 2013/3
N2 - Objectives: We retrospectively analysed the results of a strategy in which coverage of the internal iliac artery (IIA) during endovascular aneurysm repair (EVAR) was routinely performed without coil embolisation. Methods: From January 2010 until May 2012, 32 patients (96.9% men; mean age 73.0 years, range 52-89 years) underwent EVAR with stent grafts extended into the external iliac artery (EIA), all without prior coil embolisation. Aneurysm morphology was determined on preoperative computed tomography (CT) images. During follow-up, patients were interviewed about buttock claudication, and the occurrence of endoleaks and evolution of aneurysm diameter were recorded. Results: At baseline, the mid-common iliac artery (CIA) diameter was 33.5 +/- 16.8 mm and seven patients presented with ruptured aneurysms. Mean follow-up was 14.3 +/- 7.4 months. There were eight deaths, none related to IIA coverage. Buttock claudication occurred in seven (22.6%) patients, which persisted after 6 months in two cases of bilateral IIA coverage. No Type-I or -II endoleaks occurred related to IIA coverage. Aneurysm growth was not observed. Conclusion: Endovascular treatment of aortoiliac and iliac aneurysm without pre-emptive coil ennbolisation of the IIA appears safe and effective. No IIA-related endoleaks or re-interventions occurred in our series. This approach saves operating time, contrast load and costs and may reduce complications. However, a larger population and longer follow-up is required to confirm our findings.
AB - Objectives: We retrospectively analysed the results of a strategy in which coverage of the internal iliac artery (IIA) during endovascular aneurysm repair (EVAR) was routinely performed without coil embolisation. Methods: From January 2010 until May 2012, 32 patients (96.9% men; mean age 73.0 years, range 52-89 years) underwent EVAR with stent grafts extended into the external iliac artery (EIA), all without prior coil embolisation. Aneurysm morphology was determined on preoperative computed tomography (CT) images. During follow-up, patients were interviewed about buttock claudication, and the occurrence of endoleaks and evolution of aneurysm diameter were recorded. Results: At baseline, the mid-common iliac artery (CIA) diameter was 33.5 +/- 16.8 mm and seven patients presented with ruptured aneurysms. Mean follow-up was 14.3 +/- 7.4 months. There were eight deaths, none related to IIA coverage. Buttock claudication occurred in seven (22.6%) patients, which persisted after 6 months in two cases of bilateral IIA coverage. No Type-I or -II endoleaks occurred related to IIA coverage. Aneurysm growth was not observed. Conclusion: Endovascular treatment of aortoiliac and iliac aneurysm without pre-emptive coil ennbolisation of the IIA appears safe and effective. No IIA-related endoleaks or re-interventions occurred in our series. This approach saves operating time, contrast load and costs and may reduce complications. However, a larger population and longer follow-up is required to confirm our findings.
KW - Aneurysm
KW - Endovascular aneurysm repair (EVAR)
KW - Internal iliac artery (IIA)
KW - Hypogastric artery
KW - Buttock claudication
KW - Type II endoleak
KW - Pelvic ischaemia
U2 - 10.1016/j.ejvs.2012.12.001
DO - 10.1016/j.ejvs.2012.12.001
M3 - Article
C2 - 23305786
SN - 1078-5884
VL - 45
SP - 220
EP - 226
JO - European Journal of Vascular and Endovascular Surgery
JF - European Journal of Vascular and Endovascular Surgery
IS - 3
ER -