|Is pre-emptive internal iliac artery embolisation really necessary?|
|Monday, 09 September 2013|
Stokmans RA, Willigendael EM, Teijink JAW, et al. Challenging the evidence for pre-emptive coil embolisation of the internal iliac artery during endovascular aneurysm repair. Eur J Vasc Endovas Surg 2013; 45: 220–6.
In a nutshell
The primary outcome measure was the occurence of type I or type II endoleak secondary to cover of the IIA ostium. Post-procedural mortality was also recorded as well as symptoms of pelvic ischaemia following the procedure. Morpholgy and aneurysmal diameters were recorded pre-operatively using contrast-enhanced spiral CT (CTA).
During the period from January 2010 to May 2012, 32 patients underwent EVAR with unilateral IIA coverage. Seven patients underwent the procedure as an emergency for ruptrued AAA or CIAA. Mean follow-up was 14.3 months. Eight patients died during the follow-up with none of the deaths related to IIA coverage.
No type II endoleaks were detected on follow-up CTAs in the study population. Increase
Sexual dysfunction was not reported although this was not routinely queried during follow-up. There were no cases of colonic ischaemia, perineal necrosis, incontinence or acute limb ischaemia reported in the series although this might result from the relatively small population size.
The study was a small retrospective study. The advent of branched endografts that allow preservation of flow into the internal iliac arteries may lead to better results, less buttock claudication and pelvic ischaemia and possibly less limb occlusions due to improved flows. Coverage of the internal iliac arteries should therefore be compared to branched endografts preserving the internal iliac arteries rather than simple embolisation both in terms of clinical outcomes and cost effectiveness.