Clinical consequences of closure of internal iliac arteries in patients with abdominal aortic aneurysms subjected to endovascular treatment

Abstract

Background. In patients with abdominal aortic aneurysms affecting the common iliac arteries and the site of their division into external and internal iliac arteries, the stent-graft should exclude both the aneurysm of the aorta and that of the iliac arteries from the circulation. In such cases the stent-graft should cover the ostium of internal iliac arteries.
Aim of the study. To determine the clinical outcome of hypogastric artery occlusion in patients who underwent endovascular treatment of aortoiliac aneurysmal disease.
Material and methods. Out of 104 patients with abdominal aortic aneurysms, 16 required occlusion of one of the hypogastric arteries because of their involvement in aneurysmal disease. In 6 patients aortounilateral iliac stent-grafts were implanted with cross-femoral by-pass grafts. In 10 patients bifurcated stent-grafts were used. In all 16 patients the hypogastric arteries were closed by means of coils.
Results. Out of 16 patients with abdominal aortic aneurysms treated with stent-grafts, 9 developed symptoms attributable to hypogastric artery embolisation. All of them had buttock claudication. One of these patients complained of a worsening of sexual function. In another patient bowel ischaemia was suspected. All the symptoms called for follow-up.
Conclusions. When treating aortoiliac aneurysmal disease through an endovascular approach, the occlusion of the internal iliac artery is often necessary but carries with it a small but finite chance of morbidity.