Potential risks of bilateral internal iliac occlusion
Bilateral internal iliac occlusion due to a stent graft can result in some potential complications:
- Gluteal claudication and necrosis in severe cases
- Erectile dysfunction
- Bowel ischemia
- Bladder ischemia
- 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 . 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.
- 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.