Skip to main content
SpringerLink
Log in

Technical and Outcome Considerations of Endovascular Treatment for Internal Iliac Artery Aneurysms

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

This study was designed to analyze the outcomes of endovascular treatment for internal iliac artery aneurysm (IIAA) at mid-term follow-up.

Methods

We retrospectively analyzed 33 patients (28 males, mean age 77.4 years) who underwent endovascular treatment of 35 IIAAs (mean diameter 39.8 mm) from 2002 to 2012. We attempted to completely and selectively embolize all distal branches with permanent embolic materials, followed by proximal controls either by stent-graft placement (type 1) or coil embolization (type 2).

Results

Procedural success rate was 97.1 % (n = 34). Complete permanent distal branches embolization was achieved in 27 (79.4 %), type 1 in 24 (70.6 %), and type 2 in 10 (29.4 %) cases. During mean follow-up period of 29.1 months (range, 1.2–92.8), no IIAA-related mortality and stent/stent-graft related complications occurred. Pelvic ischemia occurred and resolved in 8 (25 %) patients. Among 32 cases followed by CT, the aneurysm diameter was stable in 18 (56.3 %), shrank in 11 (34.4 %), and enlarged in 3 (9.4 %) cases. In 22 assessed by contrast-enhanced CT, secondary endoleak occurred in 3 (13.6 %) cases and 2 required secondary interventions (2/32, 6.3 %). Type 1 procedure tends to have better mid-term outcomes. Incomplete permanent distal branches embolization was associated with enlargement and secondary intervention (p = 0.007 and p = 0.042, respectively). The secondary intervention-free rate at 3 years in the complete and incomplete distal embolization group was 100 and 83.3 %, respectively (p = 0.128).

Conclusions

Endovascular treatment for IIAA is feasible and safe. Complete permanent distal branches embolization is important to achieve satisfactory mid-term outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Uberoi R, Tsetis D, Shrivastava V, Morgan R, Belli AM (2011) Standard of practice for the interventional management of isolated iliac artery aneurysms. Cardiovasc Intervent Radiol 34(1):3–13

    Article  PubMed  Google Scholar 

  2. Dix FP, Titi M, Al-Khaffaf H (2005) The isolated internal iliac artery aneurysm-a review. Eur J Vasc Endovasc Surg 30(2):119–129

    Article  CAS  PubMed  Google Scholar 

  3. Haslam JE, Hardman J, Horrocks M, Fay D (2009) Customized tapered stent-grafts in the endovascular management of internal iliac artery aneurysms: a useful adjunct to conventional endovascular options. Cardiovasc Intervent Radiol 32(1):139–144

    Article  PubMed  Google Scholar 

  4. Okada T, Yamaguchi M, Kitagawa A, Kawasaki R, Nomura Y, Okita Y, Sugimura K, Sugimoto K (2012) Endovascular tubular stent-graft placement for isolated iliac artery aneurysms. Cardiovasc Intervent Radiol 35(1):59–64

    Article  PubMed  Google Scholar 

  5. Melki JP, Fichele JM, Cormier F, Marzelle J, Cormier JM (2001) Embolization of hypogastric artery aneurysm: 17 cases. Ann Vasc Surg 15(3):312–320

    Article  CAS  PubMed  Google Scholar 

  6. Millon A, Paquet Y, Ahmed SB, Pinel G, Rosset E, Lermusiaux P (2013) Midterm outcomes of embolisation of internal iliac artery aneurysms. Eur J Vasc Endovasc Surg 45(1):22–27

    Article  CAS  PubMed  Google Scholar 

  7. Cambj-Sapunar L, Maskovic J, Brkljacic B, Radonic V, Dragicevic D, Ajduk M (2010) Outcome of emergency endovascular treatment of large internal artery aneurysms with guidewires. Eur J Radiol 74(1):86–92

    Article  PubMed  Google Scholar 

  8. Soury P, Brisset D, Gigou F, Saliou C, Angel F, Laurian C (2001) Aneurysms of the internal iliac artery: management strategy. Ann Vasc Surg 15(3):321–325

    Article  CAS  PubMed  Google Scholar 

  9. Cynamon J, Marin ML, Veith FJ, Bakal CW, Silberzweig JE, Rozenblit A, Wahl SI (1995) Endovascular repair of internal iliac artery aneurysm with use of a stented graft and embolization coils. J Vasc Intervent Radiol 6(4):509–512

    Article  CAS  Google Scholar 

  10. Henry M, Amor M, Henry I, Tzvetanov K, Buniet JM, Amicabile C (1998) Endovascular treatment of internal iliac aneurysms. J Endovasc Surg 5(4):345–348

    Article  CAS  PubMed  Google Scholar 

  11. Wolf F, Loewe C, Cejna M, Schoder M, Rand T, Kettenbach J, Dirisamer A, Lammer J, Funovics M (2008) Endovascular management performed percutaneously of isolated iliac artery aneurysms. Eur J Radiol 65(3):491–497

    Article  PubMed  Google Scholar 

  12. Mori M, Sakamoto I, Morikawa M, Kohzaki S, Makino J, Matsunaga N, Amamoto Y, Hayashi K (1999) Transcatheter embolization of internal iliac artery aneurysms. J Vasc Intervent Radiol 10(5):591–597

    Article  CAS  Google Scholar 

  13. Wolpert LM, Drezner D, Hallisey MJ, Gallagher JJ, Wildels MH (2004) Transcatheter embolization of hypogastric artery aneurysms: lessons learned. Ann Vasc Surg 18(4):474–480

    Article  PubMed  Google Scholar 

  14. Heye S, Vaninbroukx J, Daenens K, Houthoofd S, Maleux G (2012) Embolization of an internal iliac artery aneurysm after image-guided direct puncture. Cardiovasc Intervent Radiol 35(4):807–814

    Article  CAS  PubMed  Google Scholar 

  15. Rayt HS, Bown MJ, Lambert KV, Fishwick NG, McCarthy MJ, London NJ, Sayers RD (2008) Buttock claudication and erectile dysfunction after internal iliac artery embolization in patients prior to endovascular aortic aneurysm repair. Cardiovasc Intervent Radiol 31(4):728–734

    Article  CAS  PubMed  Google Scholar 

  16. Mehta M, Veith FJ, Darling RC, Roddy SP, Ohki T, Lipsitz EC, Paty PS, Kreienberg PB, Ozsvath KJ, Chang BB, Shah DM (2004) Effects of bilateral hypogastric artery interruption during endovascular and open aortoiliac aneurysm repair. J Vasc Surg 40(4):698–702

    Article  PubMed  Google Scholar 

  17. Bratby MJ, Munneke GM, Belli AM, Loosemore TM, Loftus I, Thompson MM, Morgan RA (2008) How safe is bilateral internal iliac artery embolization prior to EVAR? Cardiovasc Intervent Radiol 31(2):246–253

    Article  CAS  PubMed  Google Scholar 

  18. Parlani G, Verzini F, De Rango P, Brambilla D, Coscarella C, Ferrer C, Cao P (2012) Long-term results of iliac aneurysm repair with iliac branched endograft: a 5-year experience on 100 consecutive cases. Eur J Vasc Endovasc Surg 43(3):287–292

    Article  CAS  PubMed  Google Scholar 

  19. Karthikesalingam A, Hinchliffe RJ, Holt PJE, Boyle JR, Loftus IM, Thompson MM (2010) Endovascular aneurysm repair with preservation of the internal iliac artery using the iliac branch graft device. Eur J Vasc Endovasc Surg 39(3):285–294

    Article  CAS  PubMed  Google Scholar 

  20. Chemelli A, Hughl B, Klocker J, Thauerer M, Strasak A, Jaschke W, Waldenberger P, Chemelli-Steingruber IE (2010) Endovascular repair of isolated iliac artery aneurysms. J Endovasc Ther 17(4):492–503

    Article  PubMed  Google Scholar 

  21. Boules TN, Selzer F, Stanziale SF, Chomic A, Marone LK, Dillavou ED, Makaroun MS (2006) Endovascular management of isolated iliac artery aneurysms. J Vasc Surg 44(1):29–37

    Article  PubMed  Google Scholar 

  22. Bade MA, Ohki T, Cynamon J, Veith FJ (2001) Hypogastric artery aneurysm rupture after endovascular graft exclusion with shrinkage of the aneurysm: significance of endotension from a “virtual”, or thrombosed type II endoleak. J Vasc Surg 33(6):1271–1274

    Article  CAS  PubMed  Google Scholar 

  23. Gemmete JJ, Arabi M, Cwikiel WB (2011) Percutaneous transosseous embolization of internal iliac artery aneurysm type II endoleak: report of two cases. Cardiovasc Intervent Radiol 34(Suppl 2):S122–S125

    Article  PubMed  Google Scholar 

  24. Abderhalden S, Rancic Z, Lachat ML, Pfammatter T (2012) Retrograde hypogastric artery embolization to treat iliac artery aneurysms growing after aortoiliac repair. J Vasc Interv Radiol 23(7):873–877

    Article  PubMed  Google Scholar 

  25. Cartwright-Terry M, Ashleigh R, Martin D, Nasim A (2006) CT-guided embolization of an isolated internal iliac artery aneurysm 8 years after AAA repair. J Endovasc Ther 13(4):561–564

    Article  PubMed  Google Scholar 

  26. Patel SD, Perera A, Law N, Mandumula S (2011) A novel approach to the management of a ruptured type II endoleak following endovascular repair of an internal iliac artery aneurysm. Br J Radiol 84(1008):e240–e242

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Conflict of interest

All of the authors declare that they have no conflict of interest and no grant support for this work.

Author information

Authors and Affiliations

  1. Center for Endovascular Therapy, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Akhmadu Muradi, Masato Yamaguchi, Takuya Okada, Yoshikatsu Nomura, Koji Idoguchi, Eisuke Ueshima, Noriaki Sakamoto & Koji Sugimoto

  2. Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Masato Yamaguchi, Takuya Okada, Eisuke Ueshima, Noriaki Sakamoto & Koji Sugimoto

  3. Cardiovascular Division, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Yoshikatsu Nomura & Yutaka Okita

  4. Department of Radiology, Hyogo Brain and Heart Center at Himeji, 520 Saishoko, Himeji, 670-0981, Japan

    Ryota Kawasaki

Authors
  1. Akhmadu Muradi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masato Yamaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takuya Okada
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoshikatsu Nomura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Koji Idoguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eisuke Ueshima
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Noriaki Sakamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ryota Kawasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yutaka Okita
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Koji Sugimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Akhmadu Muradi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Muradi, A., Yamaguchi, M., Okada, T. et al. Technical and Outcome Considerations of Endovascular Treatment for Internal Iliac Artery Aneurysms. Cardiovasc Intervent Radiol 37, 348–354 (2014). https://doi.org/10.1007/s00270-013-0689-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-013-0689-9

Keywords

Search

Navigation