Abstract Archives of the RSNA, 2014
Alexander Dierks MD, Presenter: Nothing to Disclose
Alexander Sauer MD, Abstract Co-Author: Nothing to Disclose
Franziska Wolfschmidt MD, Abstract Co-Author: Nothing to Disclose
Nicole Hassold MD, Abstract Co-Author: Nothing to Disclose
Thorsten Alexander Bley MD, Abstract Co-Author: Nothing to Disclose
Ralph Kickuth MD, Abstract Co-Author: Nothing to Disclose
Prior to endovascular aortoiliac aneurysm repair (EVAR) occlusion of the internal iliac artery (IIA) may be necessary to prevent an endoleak type II. We compared efficacy and clinical outcome after proximal occlusion of an unaffected IIA (ProxEmbx) using the Amplatzer vascular plug I (AVP) vs. distal occlusion of aneurysmatic IIA with coils and plugs (DistEmbx).
Between 04/2009 and 12/2012 22 patients (mean age 74±8 years) underwent EVAR. In 9 patients with unaffected IIA occlusion was performed by a single AVP. In 13 patients with aneurysmatic IIA more distal embolization was conducted by using several coils and additional AVPs. The follow-up (mean 15±12.4 months) was based on clinical and radiological examinations (CTA and CEUS). Retrospectively, technical success, clinical outcome and complications were evaluated.
Embolization of the IIA was successful in all patients. Three patients with more distal embolization of aneurysmatic IIAs suffered from new onset sexual dysfunction after occlusion without statistically significant difference (p>0.05). Transient buttock claudication was observed in three patients in each group. Bowel ischemia did not occur. The procedure time in the ProxEmbx group was significantly lower (43±20 vs. 73±29 minutes; p=0.013). Fluoroscopy time for the ProxEmbx was also lower (14.6±4 vs. 29.2±7 minutes; p=0.038). There was no significant difference concerning radiation exposure (p>0.05), which was related to different BMI in both groups. There was no difference in the amount of contrast media (p>0.05).
Proximal occlusion of an unaffected IIA as well as more distal occlusion of an aneurysmatic IIA prior to EVAR have both the same technical and clinical outcome. However, proximal plug embolization has a significant lower procedure and fluoroscopy time.
Proximal plug embolization of an unaffected IIA prior to EVAR is associated with shorter procedure and fluoroscopy time in comparison to more distal embolization of aneurysmatic IIAs.
Proximal vs. Distal Occlusion of the Internal Iliac Artery Prior EVAR: Evaluation of Efficacy and Clinical Outcome. Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045688.html