Bilateral Internal Iliac Artery Embolization Research Articles

Application of internal iliac artery interruption in management of pelvic hemorrea caused by pelvic fracture or other conditions

Total 59 cases of pelvic hemorrhea caused by pelvic fracture or other conditions were treated with internal iliac artery interruption from 1999 to 2007. Among them 33 case were treated with bilateral internal iliac artery ligation during exploratory celiotomy; 26 underwent bilateral internal iliac artery angiography through left femur artery puncture. In angiography the hemorrhage site was identified in 19 cases and high-selective embolization with gelatin sponge was followed; for 7 cases the hemorrhage site was not confirmed, the bilateral internal iliac artery embolization was used. In all 59 cases pelvic hemorrhage was stopped; the results indicate that internal iliac artery interruption is effective and save in management of pelvic organ hemorrhea caused by pelvic fracture or other conditions. Key words: Hip fractures; Shock; hemorrhagic

How Safe is Bilateral Internal Iliac Artery Embolization Prior to EVAR?

How Safe is Bilateral Internal Iliac Artery Embolization Prior to EVAR?

How Safe is Bilateral Internal Iliac Artery Embolization Prior to EVAR?

To assess the outcomes of patients after bilateral internal iliac artery (IIA) embolization prior to endovascular aneurysm repair (EVAR). Thirty-nine patients (age range 55-88 years, mean 72.5 years; 2 women) underwent IIA embolization/occlusion before EVAR. There were 28 patients with aorto-biiliac aneurysms and 6 with bilateral common iliac artery (CIA) aneurysms. Five patients with unilateral CIA aneurysms had previous surgical ligation of the contralateral IIA or inadvertent covering by the stent-graft of the contralateral IIA origin. Outcomes were assessed by clinical follow-up. Severe ischemic complications were limited to spinal cord ischemia in 1 patient (3%) who developed paraparesis following EVAR. No other severe ischemic complications such as buttock necrosis, or bowel or bladder ischemia, occurred. Buttock and/or thigh claudication occurred in 12 patients (31%) and persisted beyond 1 year in 3 patients (9%). Sexual dysfunction occurred in 2 patients (5%). Patients who underwent simultaneous embolization had a 25% (3/12) ischemic complication rate versus 41% (11/27) in those with sequential embolization (p = 0.48). Embolization limited to the main trunk of the IIA resulted in a significantly reduced ischemic complication rate of 16% (3/19) versus 55% (11/20) of patients who had a more distal embolization of the IIA (p = 0.019, Fisher's exact test). Severe complications after bilateral IIA embolization are uncommon. Although buttock/thigh claudication occurs in around 30% of patients soon after the procedure, this resolves in the majority after 1 year. There is no obvious benefit for sequential versus simultaneous IIA embolization in our series. Occlusion of the proximal IIA trunk is associated with reduced complications compared with occlusion of the distal IIA.

Male Sexual Function After Bilateral Internal Iliac Artery Embolization for Pelvic Fracture

No AccessJournal of UrologyUrological Survey: Abstracts: Trauma, and Genital and Urethral Reconstruction1 Dec 2004Male Sexual Function After Bilateral Internal Iliac Artery Embolization for Pelvic Fracture Allen F. MoreyM.D. Allen F. MoreyAllen F. Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)61492-9AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Male Sexual Function After Bilateral Internal Iliac Artery Embolization for Pelvic Fracture." The Journal of Urology, 172(6 Part 1), p. 2510 © 2004 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 172Issue 6 Part 1December 2004Page: 2510 Advertisement Copyright & Permissions© 2004 by American Urological Association, Inc.MetricsAuthor Information Allen F. Morey More articles by this author Expand All Advertisement Loading ...

Male sexual function after bilateral internal iliac artery embolization for pelvic fracture.

Bilateral internal iliac artery embolization (BIIAE) effectively controls unlocalized bleeding from pelvic fractures. Its short-term safety has been documented, but its long-term effect on urogenital function has not been evaluated. Patients having temporary BIIAE with gelatin sponge slurry for pelvic fractures were prospectively identified. Two control groups were created--one with similar pelvic fractures but no embolization, and the other with nonpelvic injuries. The groups were matched for risks of urogenital dysfunction: age, time elapsed since injury, Injury Severity Score, pelvic Abbreviated Injury Scale score, and presence of urethral or bladder injuries. Urogenital function was assessed at least 1 year after injury using a validated questionnaire. Sexual function was significantly compromised in patients having pelvic fractures compared with those not having fractures. There was no difference in sexual function between patients having pelvic fractures treated with BIIAE and those having pelvic fractures alone. BIIAE does not produce lasting adverse effects on urogenital function. Sexual dysfunction frequently occurs after traumatic pelvic fracture and is produced by the injury itself.

Fetal growth and Doppler assessment in patients with a history of bilateral internal iliac artery embolization

Fetal growth and Doppler assessment in patients with a history of bilateral internal iliac artery embolization

Fetal growth and Doppler assessment in patients with a history of bilateral internal iliac artery embolization

Background: Pregnancy occurring after pelvic arterial embolization for postpartum hemorrhage is rare. The harmlessness of this procedure for subsequent pregnancies is poorly documented.Materialsand methods: Eight pregnant women with a history of arterial embolization were followed up with fetal growth and Doppler assessment.Results: Fetal growth and umbilical Doppler findings remainednormal in all cases.Conclusion: Embolization, a life-saving and fertility-preserving procedure, does not seem to affect subsequent pregnancies.

A prospective evaluation of hypogastric artery embolization in endovascular aortoiliac aneurysm repair

Purpose: Hypogastric artery embolization (HAE) is often performed in endovascular aortoiliac aneurysm repair to prevent potential endoleak, and this can be associated with pelvic ischemic sequelae. This prospective study was performed to evaluate the clinical outcome of HAE in patients who underwent endovascular aortoiliac aneurysm repair. Methods: During a 15-month period, 12 patients who underwent either unilateral or bilateral HAE for endovascular aortoiliac aneurysm repair were prospectively evaluated. All patients underwent preoperative and postoperative penile pressure measurement and pulse-volume recording evaluation. Angiographic features relating to pelvic collaterals and clinical outcomes relating to pelvic ischemia were evaluated. Results: Unilateral HAE was performed in eight patients (67%), and bilateral HAE was performed in four patients (33%). Mean reductions in penile brachial index (PBI) after unilateral and bilateral HAE were 13 ± 6% (not significant) and 39 ± 14% ( P < .05), respectively. Erectile dysfunction occurred in three patients for unilateral HAE (38%) and in two patients for bilateral HAE (50%), with an overall PBI reduction of 36 ± 12% ( P < .01). No significant change in thigh brachial or ankle brachial index occurred after HAE. Hip and buttock claudication occurred in four patients for unilateral HAE (50%) and in two patients for bilateral HAE (50%), with an overall PBI reduction of 18 ± 9% ( P < .05). Other associated pelvic ischemic complications after bilateral HAE included one scrotal skin sloughing (25%) that occurred 3 days after aortic endografting and one sacral decubitus (25%) that occurred 4 months after aortic endografting. With analysis of angiographic collateral patterns, diseased profunda femoral artery (PFA; >50% stenosis) was noted in four patients, all in whom post-HAE pelvic ischemic symptoms developed ( P < .05). In contrast, only four of the remaining eight patients with normal or mild PFA disease had pelvic ischemic sequelae after HAE. Conclusion: Erectile dysfunction after HAE correlates with significant reduction in PBI. Severe pelvic ischemic symptoms are more likely to occur after bilateral HAE, which should be avoided if possible. Moreover, patients with diseased PFA are at risk of development of pelvic ischemia after HAE. Our data suggest a potential role of concomitant profundapalsty at the time of aortic endografting to improve pelvic collateral flow and reduce pelvic ischemia in this subset of patients with HAE. (J Vasc Surg 2002;36:500-6.)

Internal Iliac Artery Embolization with Bilateral Occlusion before Endovascular Aortoiliac Aneurysm Repair—Clinical Outcome of Simultaneous and Sequential Intervention

To retrospectively evaluate the clinical outcome of patients after simultaneous or sequential internal iliac artery (IIA) embolization for bilateral IIA occlusion. Sixteen patients (65-88 y; mean, 75.6 y; two women), 11 with aortobiiliac aneurysms, three with bilateral common iliac artery (CIA)/IIA aneurysms, and two with unilateral CIA/IIA aneurysms, underwent IIA occlusion before endovascular aortoiliac repair. Eight patients underwent simultaneous bilateral IIA embolization before endovascular aortic repair (EVAR). Eight patients had sequential bilateral IIA occlusion. The outcome was assessed by clinical follow-up. There were no severe ischemic complications such as buttock necrosis or acute bowel, bladder, or spinal cord ischemia. Early ischemic complications occurred in 25% (buttock/thigh claudication, n = 3, 18.8%; and sexual dysfunction, n = 1, 6.2%) and had an onset not later than 6 months after intervention: buttock claudication resolved (n = 2) or persisted after aggravation by inferior mesenteric artery embolization for type II endoleak (n = 1). Impotence in a fourth patient persisted. The ischemic complication rate after 6 months was 30% (three of 10) because of a fifth patient who developed ischemic colitis with aggravation of ischemic heart disease after 15 months. The mean follow-up duration was 19.7 months. Patients with simultaneous embolization had a lower complication rate than those with sequential embolization (one of eight [12.5%] vs four of eight [50%], respectively). IIA embolization for bilateral IIA occlusion can be performed with a complication rate comparable with results of previous studies of unilateral IIA embolization. Chronic buttock claudication may be aggravated by embolization of aortic side branches. Late complications can have an insidious course and be initiated by low-output cardiac failure. Bilateral IIA occlusion is recommended only in patients who are considered unfit for aortic surgery.

Use of Aortic Cuffs to Exclude Iliac Artery Aneurysms during AneuRx Stent-Graft Placement: Initial Experience

As many as 39% of patients who undergo aortic endografting for abdominal aortic aneurysm disease will have ectasia of the iliac arteries that will require intervention. Coil embolization of the internal iliac artery and extension of the graft to the external iliac artery is one solution to this problem. However, 19%-41% of these patients experience buttock claudication, which may be permanent, after unilateral embolization. The authors examined an alternative: the use of larger-sized aortic cuffs to seal the iliac limb. Outcomes and short-term results are presented in this article. From October 1999 to August 2000, 144 AneuRx stent-grafts were placed at the authors' institution. Among the population receiving stent-grafts, 14 patients had 15 aortic cuffs placed across the distal iliac graft limbs to seal them and preserve flow to the internal iliac artery. One patient had bilateral cuffs placed. Five patients had embolization of the contralateral internal iliac artery because of bilateral disease. Patients were followed with computed tomography (CT) at 1, 6, and 12 months to evaluate for endoleaks. One- and 6-month endoleak rates, determined from only those patients with follow-up CT, were 0% and 10%, respectively. One type II endoleak was first discovered 9 months after graft placement. It sealed spontaneously at 15-month follow-up. One patient among the five who had internal iliac artery embolization had claudication. Mean CT follow-up was 7.8 months (range, 1-15). One patient declined CT but was alive and well 11 months after endografting. One patient moved across the country and declined follow-up. Placement of aortic cuffs in dilated iliac arteries can preserve flow to the ipsilateral internal iliac artery and provide an adequate seal. Additionally, the option of later treatment is maintained. Patients with bilateral iliac ectasia can undergo stent-graft placement without bilateral internal iliac artery embolization. Longer-term follow-up in larger numbers of patients will be important to determine the ultimate durability of this technique.

Giant uterine leiomyoma devascularized by embolization prior to surgical removal

A 49-year-old woman presented a tumor of pelvic origin filling almost the whole abdominal cavity. Angiography confirmed that it arose from the uterus. Bilateral internal iliac artery embolization was performed prior to surgical removal. It was found to be a 25 kg uterine leiomyoma.

Sloughing of the scrotal skin and impotence subsequent to bilateral hypogastric artery embolization for endovascular aortoiliac aneurysm repair

Sloughing of the scrotal skin is an extremely rare event due to pelvic ischemia. We report herein one case of scrotal skin sloughing and impotence after bilateral hypogastric artery embolization for endoluminal aortoiliac aneurysm repair. Postoperative penile plethysmography demonstrated a 75% reduction in the penile brachial index, suggesting that pelvic ischemia is the main culprit for this complication. The devastating morbidity in our patient underscores the importance of maintaining pelvic collateral circulation when planning for endovascular aortoiliac aneurysm repair. (J Vasc Surg 2001;34:748-50.)

Hypogastric artery embolization in endovascular abdominal aortic aneurysm repair

Purpose: Iliac artery anatomy is a central factor in endoluminal abdominal aortic aneurysm therapy. It serves as the conduit for graft deployment and as the region of distal graft seal. Thirty-eight percent of iliac vessels in our patients require special treatment because of aneurysms, tortuosity, or small size. Bilateral hypogastric artery exclusion has been avoided because of concerns of colorectal ischemia, hip/buttock claudication, and impotence. We suggest that elective, staged, bilateral hypogastric embolization can be performed safely with reasonably low morbidity and can expand the anatomic boundaries for stent-graft abdominal aortic aneurysm repair. Methods: This study was performed as a retrospective chart review of patients requiring hypogastric artery embolization for endovascular repair of abdominal aortic aneurysms between June 1998 and June 2000. Patients with otherwise appropriate anatomy and common iliac artery aneurysms were informed of the option for stent-graft repair with internal iliac artery embolization with its risks of impotence, hip/buttock claudication, and bowel ischemia. Patients underwent unilateral or staged bilateral coil embolizations of their proximal hypogastric arteries with an approximate 1-week interval between procedures. Hospital and office records were reviewed; phone interviews were performed. Follow-up ranged from 1 to 12 months. Results: During a 24-month period, 65 patients underwent endovascular abdominal aortic aneurysm repair; 18 patients (28%) required hypogastric artery embolization. Seven (39%) of these patients underwent bilateral embolization. There were no episodes of clinically evident bowel ischemia. Lactate levels were normal in all measured patients. Postoperative fevers (> 101.0°F) were documented in 10 (56%) of 18 patients. The average white blood cell count was 12.8 × 10 9/L (range, 8.5-22.9). There were no positive blood culture results. The return to the full preoperative diet occurred in 1 to 3 days. Hip/buttock claudication occurred in approximately 50% of patients with persistent but improved symptoms at 6 months. Eighty-seven percent of patients had preoperative erectile dysfunction. Only two patients noted worsening of erectile function postoperatively. Conclusions: Preliminary results indicate that bilateral hypogastric artery embolization can be performed, when necessary, with reasonable morbidity in patients undergoing stent-graft abdominal aortic aneurysm repair. (J Vasc Surg 2001;33:1193-8.)

Advanced vulvar carcinoma treated with internal iliac arterial embolization therapy after radiotherapy

Two patients with vulvar carcinoma are reported who were treated with internal iliac transcatheter arterial embolization and radiotherapy. Patient 1 had T 3N 3M 0 vulvar carcinoma. The lesion remaining after radiotherapy was treated by bilateral internal iliac arterial embolization. Vulvectomy was then performed, and the resected specimen showed no residual malignant cells. This patient is alive without recurrence 4 years 7 months after operation. Patient 2 (T 3N 0M 0 vulvar carcinoma) underwent radiotherapy, and the remaining malignant tumor disappeared after bilateral internal iliac artery embolization. This patient has remained disease free without vulvectomy for 3 years after treatment.

Uterine arteriovenous malformation successfully embolized with a liquid polymer, isobutyl 2-cyanoacrylate

A uterine arteriovenous malformation was diagnosed angiographically in a 27-year-old woman presenting with recurrent menometrorrhagia. Bilateral hypogastric artery embolization with a liquid polymer, isobutyl 2-cyanoacrylate (Bucrylate), resulted in subsequent normal menses. Bucrylate offers a number of advantages over other agents previously used to embolize uterine arteriovenous malformations.