When Should the Internal Iliac Arteries be Preserved in Patients Undergoing Endovascular or Open Repair of Aortoiliac Aneurysms?

Abstract

-Internal iliac artery (IIA) occlusion during aortic aneurysm repair has been associated with considerable morbidity. We analyzed the consequences of interrupting one or both IIAs in the standard surgical or endovascular treatment of aortoiliac aneurysms (AIAs). From 1992 to 2000, 158 patients with abdominal aortic aneurysms (n = 66), iliac aneurysms (n = 28), or AIAs (n = 64) required interruption of one (n = 134) or both (n = 24) IIAs as part of their endovascular (n = 110) or open repair (n = 48). Endovascular treatment was performed with a variety of industry- or surgeon-made grafts in combination with coil embolization of the IIAs. The standard surgical techniques included oversewing or excluding the origins of the IIAs, and extending the prosthetic graft to the external iliac or femoral artery. There were no cases of buttock necrosis, ischemic colitis requiring laparotomy, or death when one or both IIAs were interrupted. Persistent buttock claudication occurred after 16 (12%) of the unilateral and 3 (13%) of the bilateral IIA interruptions. Impotence occurred in 7 (9%) of the unilateral and 2 (11%) of the bilateral IIA interruptions. Minor neurological deficits of the lower extremity were observed in 2 (1.5%) of the patients with unilateral IIA interruption. Although IIA flow should be preserved if possible, selective interruption of one or both IIAs can usually be accomplished safely during endovascular and open repair of anatomically challenging AIAs. We believe other comorbid factors, such as shock, distal embolization, or the failure to preserve collateral branches from the external iliac and femoral arteries, may have contributed to the morbidity in other reports of IIA interruption.