Peter Biegler MD, Presenter: Nothing to Disclose

Sanjay Misra MD, Abstract Co-Author: Nothing to Disclose

Michael A. McKusick MD, Abstract Co-Author: Nothing to Disclose

Madelyn Siwady MBBCh, Abstract Co-Author: Nothing to Disclose

To access the clinical outcomes of internal iliac artery balloon angioplasty without or with stenting in patients with buttock claudication.

Between 2000 and 2010, 41 patients (men=76%; mean age 69.2 ± 9.0) underwent 43 separate endovascular interventions including angioplasty (n=43; 100%) without or with stenting (n=8; 19%) of the internal iliac artery for buttock claudication after excluding patients for critical limb ischemia or prior aortoiliac surgical revascularization. Patient demographics and cardiovascular risk factors were determined by chart review and ICD9 codes. Preprocedure upper thigh-brachial indices were 0.82 ± 0.22. Diagnostic angiography was performed with disease classified as stenosis greater than 50% including occlusion. Retrospective chart review of the electronic clinical notes was used to determine symptom resolution with 3 patients lost to follow-up and included in the failure group.

The technical success rate was 100% with two dissections treated with stenting. Symptom resolution was achieved in 35 procedures (88%) with symptom free survival averaging 17.3 months. There were 29 procedures (67%) that demonstrated bilateral internal iliac artery disease with symptom resolution in 76% of cases and an average of 15.2 months of symptom free survival. There was improvement in this bilateral internal iliac artery disease group when there was bilateral treatment of inflow disease (either the common and/or internal iliac arteries) with 87% achieving symptom resolution averaging 17.0 months in the bilateral treatment group (n=15) compared to 64% and 12.5 months respectively in the unilateral treatment group (n=14).

Treatment of buttock claudication with angioplasty and/or stenting of the internal iliac artery is safe and technically feasible. There was a high rate of symptomatic resolution with symptom free survival averaging greater than 1 year.  There was improvement in clinical outcomes when inflow disease to the buttock musculature was treated bilaterally.

Bilateral endovascular treatment of inflow disease to the internal iliac artery may be an underutilized therapy for persistent buttock claudication.

Biegler, P, Misra, S, McKusick, M, Siwady, M, Endovascular Treatment of the Internal Iliac Artery for Buttock Claudication.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11014389.html