Abstract No. 207: Internal Iliac Artery Embolization Prior to EVAR: Comparison of the AMPLATZER® Vascular Plug to Conventional Coils

Abstract

Internal iliac artery (IIA) embolization is routinely performed prior to endovascular repair of aortoiliac and isolated common iliac artery (CIA) aneurysms. The purpose of this study was to compare main trunk IIA embolization using the AMPLATZER® Vascular Plug (AVP) to conventional coil embolization with regards to cost, procedure time, number of angiographic runs, and late development of an endoleak. We retrospectively reviewed 34 cases between September 2004 and July 2008 of main trunk IIA embolization prior to endovascular stent graft repair of either aortoiliac (21) or isolated CIA aneurysms (8), or revision of preexisting endovascular stent grafts (5). In 14 patients embolization was performed with the AVP, and in the remaining 20 patients, embolization was performed with conventional coils. In each case, the total number of plugs/coils and their cost were determined. Procedure time and number of angiographic runs, both from initial IIA catheterization to vessel occlusion, were reviewed. There was no significant difference in average IIA diameter between the two groups. IIA occlusion was obtained with a single AVP in 12 of the 14 patients, and with two AVPs in the remaing two. An average of 7.8 (+/- 3.7) coils were used in the 20 patients undergoing coil embolization. Average cost of embolization with the AVP was $443.39, significantly lower than the $621.12 average cost of coil embolization (P value 0.035). Average time from initial IIA catheterization to vessel occlusion was also significantly decreased when the AVP was used over coils (23.7 vs 34.7 minutes, P value 0.035). No statistically significant difference in number of angiographic runs was noted. Follow-up CT angiograms were available in 12/14 patients who underwent AVP embolization, and in 17/20 patients who underwent coil embolization (mean followup 10.7 months), none of which demonstrated the presence of endoleak related to the IIA or distal iliac limb. In patients undergoing endovascular stent graft repair of aortoiliac or CIA aneurysms, successful IIA embolization can be performed both at a lower cost and with shorter procedure time with the AVP as compared to conventional coils.