Potential risks of bilateral internal iliac occlusion

Potential risks of bilateral internal iliac occlusion

Bilateral internal iliac occlusion due to a stent graft can result in some potential complications:

  1. Gluteal claudication and necrosis in severe cases
  2. Erectile dysfunction
  3. Bowel ischemia
  4. Bladder ischemia
  5. Spinal ischemia

Coil embolisation of internal iliacs is resorted to for preventing type II endoleak when the aortic stent grafts needs to be extended into the external iliac arteries.

In a series by Engelke C et al, 11 with aorto bi-iliac aneurysms, 3 with bilateral common iliac / internal iliac artery aneurysms and 2 with unilateral common iliac / internal iliac aneurysms underwent internal iliac embolization before endovascular aortic repair. Of these, 8 patients underwent simultaneous bilateral internal artery embolization before endovascular aortic repair (EVAR) while another 8 underwent sequential bilateral internal artery occlusion [1]. In this small series, those who underwent simultaneous embolization had lower complication rates (one in eight versus 4 in eight). In this series there were no severe ischemic complications like necrosis of the buttock, acute bowel, bladder or spinal cord ischemia. Gluteal claudication occurred in 3, of which 2 resolved, while another was aggravated after inferior mesenteric artery embolization for type II endoleak. Impotence persisted in a patient. Ischemic colitis developed in a patient with aggravation of ischemic heart disease after 15 months.

Reference

  1. Engelke C, Elford J, Morgan RA, Belli AM. Internal iliac artery embolization with bilateral occlusion before endovascular aortoiliac aneurysm repair-clinical outcome of simultaneous and sequential intervention. J Vasc Interv Radiol. 2002 Jul;13(7):667-76.