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Vascular plug safe, effective for internal iliac artery embolization
Embolization of the internal iliac artery with a vascular plug during or before endovascular abdominal aortic aneurysm repair resulted in a high rate of technical success and few adverse events, according to results of a recent retrospective study.
Researchers reviewed data from 169 patients with abdominal aortic aneurysm (mean age, 75 years; 160 men) who underwent unilateral (n = 158) or bilateral (n = 11) internal iliac embolization between 2007 and 2013. Embolization was performed using the Amplatzer Vascular Plug (St. Jude Medical) in all cases, either before (65 patients; mean delay between procedures, 18.4 days) or during endovascular aneurysm repair (104 patients). Patients underwent CT and/or ultrasound imaging 1 month after treatment, then annually. Mean follow-up was 19.8 months.
Patients were treated using a contralateral approach in 121 cases and an ipsilateral approach in 48. The overall technical success rate for embolization was 97.6%, with one failure attributed to device migration, one to release outside the target zone and two to navigation failure. Embolization required a mean of 1.43 plugs, 111 mL of contrast agent and 127,777 mGy/cm2 of radiation. Total fluoroscopy time was 854 seconds.
Eight patients exhibited early stent iliac limb occlusion and underwent thrombectomy, which was successful in three cases; the remaining five patients subsequently received femoro-femoral bypass. Intestinal ischemia was observed in two patients shortly after treatment. Both patients underwent a Hartmann’s procedure and exhibited no other complications.
Researchers observed no recanalization of the internal iliac artery trunk during follow-up. Buttock claudication occurred in 41 patients immediately after embolization and was resolved in 24 cases at the first follow-up session. Seven patients exhibited persistent claudication that limited their lifestyle. Two patients developed intestinal ischemia that required limited bowel resection. No patients developed buttock necrosis or visceral or medullar ischemia. Nineteen patients died, with one death secondary to pre-repair aneurysm rupture.
Among patients who underwent embolization before repair, 13 developed buttock claudication, four had limb branch thrombosis and one developed colonic ischemia vs. 28 cases of buttock claudication (P = .38), seven of limb branch thrombosis (P = .9) and one colonic ischemia (P = 1) among patients who underwent embolization during aneurysm repair.
On follow-up CT, 36 patients had endoleaks in the aneurismal sac, including one type 1 and 35 type 2 endoleaks. No patients exhibited endoleaks of type 3 or 4.
“While the current development of the various techniques available for the revascularization of [iliac artery aneurysms] is still ongoing, the [Amplatzer vascular plug] remains a major device option in prevention and treatment of backflow from the [iliac artery aneurysm] in aortoiliac aneurysm repair,” the researchers concluded. – by Adam Taliercio
Disclosure: The researchers report no relevant financial disclosures.