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Outcome Of Selective Embolization Of Internal Iliac Arteries Versus Common Iliac Arteries During Extensive Evar
Ye Rim Park, B.S., Jeffrey C. Hnath, MD, R. Clement Darling III, MD;
Albany Medical College, Albany, NY, USA
OBJECTIVES: Endovascular aortic aneurysm repair (EVAR) often requires limb extension to the external iliac artery past the origin of the internal iliac artery (IIA). The IIA can be coil embolized to prevent type 2 endoleaks, however sometimes catheter access to the IIA is not technically feasible. An option in these cases is to just coil embolize the common iliac artery (CIA) without IIA embolization. The purpose of this study is to evaluate outcomes of common iliac artery coil embolization as a possible alternative to direct IIA embolization.
METHODS: A retrospective review of a single center vascular surgery database was queried for CIA and IIA coil embolizations during EVAR from 11/01/2002 to 03/21/2023. Patients were divided into a group for IIA coiling and another for CIA coiling without IIA coiling. Demographics, comorbidities, operative details, complications, and additional interventions were tabulated and groups were compared using standard statistical analysis.
RESULTS: 552 EVARs with iliac coil embolizations (509 IIA and 43 CIA) were performed with a mean age of 76 years (range 58-95) and 72.4 (41-100) respectively (p=0.018). There were more males in IIA (460, 90.4% vs 34, 79.1% p=0.034). Comorbidities were similar except for more tobacco use in CIA (173, 34.0% vs 25, 58.14%; p=0.0015). Mean aneurysm size was greater in CIA (5.2 cm, range 2.2 - 11.5 vs 6.0 cm, range 2.8 - 10 p=0.007). Mean estimated blood loss was 308 mL (range 10-10,000) in IIA and 342.6 mL (25-2000) (p=0.741). Perioperative complication rates were similar. (IIA 115, 22.6% vs CIA 14, 32.56%; p=0.187). Post-op mortality differences were similar (IIA 12, 2.36% vs CIA 1, 2.33%; p=1). CIA had a significantly higher risk of 30-day readmission (IIA 6, 1.18% vs CIA 3, 6.98%; p=0.027). Post operative revision rate was similar (IIA 61, 11.98% vs CIA 3, 6.98%; p=0.458).
CONCLUSIONS: Aortic aneurysmal degeneration often extends to the iliac arteries requiring limb extension to the external iliac artery. Sacrifice of the internal Iliac artery may be difficult secondary to vessel tortuosity or a stenotic internal iliac orifice precluding selective internal iliac embolization. This series demonstrates that coil embolization of the common iliac artery offers similar outcomes compared to selection and embolization of the internal iliac artery.
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