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Endovascular aortoiliac aneurysm repair: comparing outcomes with vascular plugs vs. coil embolization of the internal iliac artery.
Travis P. Webb, MD, David P. Franklin, MD, John L. Gray, MD, Robert P. Garvin, MD, Jennifer A. Sartorius, MS, James R. Elmore, MD.
Geisinger Medical Center, Danville, PA, USA.
OBJECTIVES:
AAA often involve iliac arteries and aortic stent-graft limbs may need to cover the internal iliac arteries (IIA). Retrograde flow from the IIA can lead to progression of the aneurysmal disease from a type II endoleak. Embolization of the IIA prior to stent graft repair, by coils or Amplatzer vascular plugs (AVP), have been used to prevent this comlication. Both coil embolization (CE) and AVP embolization (AVPE) have been shown to be successful techniques, but there is less data regarding AVP. We analyzed our single insitution outcomes and complications, of CE and AVPE. This data represents a larger series of IIA embolization prior to AAA endograft placement than previously reported.
METHODS:
A retrospective chart review using the electronic health record was undertaken reviewing all patients that had undergone IIA embolization prior to AAA stent graft repair. A total population of 55 patients: 27 patients underwent CE and 28 patients underwent AVPE. Patient characteristics and comorbidities were documented. Patient outcomes and complications that were recorded are discussed in the results section.
RESULTS:
There were no major complications (death, MI, stroke) within 6 months post procedure. Buttock claudication at one month was 14.8% for CE and 28.6% for AVPE cases (p=0.078). Buttock claudication persisted in 7.4% of CE and 17.9% for AVPE cases (p=0.054) at one year. Unintended coil embolization occurred in 2 CE cases. There was one endoleak in each group on the 6 month CT scan that was unrelated to the site of IIA embolization (endoleak rate, P=NS).
Among the cases performed in a staged fashion, separate from the AAA procedure, significantly lower fluoroscopy time (CE: 28.9 min vs. AVPE 15.6 min, p=0.014), procedure time (CE: 99.3 min vs. AVPE 67.9, p=0.035) and radiation dosage (CE: 919Gycm2 vs. AVPE: 367 Gycm2, p=0.017) were observed in the AVP cases
CONCLUSIONS:
Our study found that CE and AVPE provide effective IIA embolization with low complication rates. Buttock claudication did not occur in the majority of patients, and completely resolved in 41% of the patients by one year. AVPE took significantly less time, therefore decreasing fluoroscopy time and radiation dosage. Given these results, we feel that AVP should be used as the preferred method for IIA embolization prior to AAA repair, if allowed by patient anatomy.
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