CardioVascular and Interventional Radiology

, Volume 31, Issue 4, pp 728–734 | Cite as

Buttock Claudication and Erectile Dysfunction After Internal Iliac Artery Embolization in Patients Prior to Endovascular Aortic Aneurysm Repair

  • H. S. Rayt
  • M. J. Bown
  • K. V. Lambert
  • N. G. Fishwick
  • M. J. McCarthy
  • N. J. M. London
  • R. D. Sayers
Clinical Investigation


Coil embolization of the internal iliac artery (IIA) is used to extend the application of endovascular aneurysm repair (EVAR) in cases of challenging iliac anatomy. Pelvic ischemia is a complication of the technique, but reports vary as to the rate and severity. This study reports our experience with IIA embolization and compares the results to those of other published series. The vascular unit database of the Leicester Royal Infirmary was used to identify patients who had undergone IIA coil embolization prior to EVAR. Data were collected from hospital case notes and by telephone interviews. Thirty-eight patients were identified; 29 of these were contactable by telephone. A literature search was performed for other studies of IIA embolization and the results were pooled. In this series buttock claudication occurred in 55% (16 of 29 patients) overall: in 52% of unilateral embolizations (11 of 21) and 63% of bilateral embolizations (5 of 8). New erectile dysfunction occurred in 46% (6 of 13 patients) overall: in 38% of unilateral embolizations (3 of 8) and 60% of bilateral embolizations (3 of 5). The literature review identified 18 relevant studies. The results were pooled with our results, to give 634 patients in total. Buttock claudication occurred in 28% overall (178 of 634 patients): in 31% of unilateral embolizations (99 of 322) and 35% of bilateral embolizations (34 of 98) (p = 0.46, Fisher’s exact test). New erectile dysfunction occurred in 17% overall (27 of 159 patients): in 17% of unilateral embolizations (16 of 97) and 24% of bilateral embolizations (9 of 38) (p = 0.33). We conclude that buttock claudication and erectile dysfunction are frequent complications of IIA embolization and patients should be counseled accordingly.


Interventional radiology Complication Abdominal aortic aneurysm Endovascular aneurysm repair Internal iliac artery Embolization Pelvic ischemia Buttock claudication Erectile dysfunction 


  1. 1.
    Parodi JC, Palmaz JC, Barone HD (1991) Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 5:491–499PubMedCrossRefGoogle Scholar
  2. 2.
    Carpenter JP, Baum RA, Barker CF et al (2001) Impact of exclusion criteria on patient selection for endovascular abdominal aortic aneurysm repair. J Vasc Surg 34:1050–1054PubMedCrossRefGoogle Scholar
  3. 3.
    Morrisey NJ, Faries PL, Carrocio A, Ellozy S, Teoderescu V, Hollier LH, Marin ML (2002) Intervention in peripheral vascular disease: intentional internal iliac artery occlusion in endovascular repair of abdominal aortic aneurysms. J Invas Cardiol 14(12):760–763Google Scholar
  4. 4.
    Yano OJ, Morrissey N, Eisen L et al (2001) Intentional iliac artery occlusion to faciliate endovascular repair of aortoiliac aneurysms. J Vasc Surg 34:204–211PubMedCrossRefGoogle Scholar
  5. 5.
    Su WT, Stone DH, Lamparello PJ, Rockman CB (2004) Gluteal compartment syndrome following elective unilateral internal iliac artery embolisation before endovascular aortic aneurysm repair. J Vasc Surg 2004:39:672–675CrossRefGoogle Scholar
  6. 6.
    Engelke C, Elford J, Morgan RA, Belli AM (2002) Internal iliac artery embolization with bilateral occlusion before endovascular aortoiliac aneurysm repair—clinical outcome of simultaneous and sequential intervention. J Vasc Interv Radiol 13(7):667–676PubMedCrossRefGoogle Scholar
  7. 7.
    Yusuf SW, Whitaker SC, Chuter TA et al (1997) Early results of endovascular aortic aneurysm surgery with aortouniiliac graft, contralateral iliac occlusion, and femorofemoral bypass. J Vasc Surg 25(1):165–172PubMedCrossRefGoogle Scholar
  8. 8.
    Razavi MK, DeGroot M, Olcott C 3rd et al (2000) Internal iliac artery embolization in the stent-graft treatment of aortoiliac aneurysms: analysis of outcomes and complications [see Comment]. J Vasc Interv Radiol 11(5):561–566PubMedCrossRefGoogle Scholar
  9. 9.
    Arko FR, Lee WA, Hill BB, Fogarty TJ, Zarins CK (2004) Hypogastric artery bypass to preserve pelvic circulation: improved outcome after endovascular abdominal aortic aneurysm repair. J Vasc Surg 39(2):404–408PubMedCrossRefGoogle Scholar
  10. 10.
    Criado FJ, Wilson EP, Velazquez OC et al (2000) Safety of coil embolization of the internal iliac artery in endovascular grafting of abdominal aortic aneurysms. J Vasc Surg 32(4):684–688PubMedCrossRefGoogle Scholar
  11. 11.
    Kritpracha B, Pigott JP, Price CI, Russell TE, Corbey MJ, Beebe HG (2003) Distal internal iliac artery embolization: a procedure to avoid. J Vasc Surg 37(5):943–948PubMedCrossRefGoogle Scholar
  12. 12.
    Karch LA, Hodgson KJ, Mattos MA, Bohannon WT, Ramsey DE, McLafferty RB (2000) Adverse consequences of internal iliac artery occlusion during endovascular repair of abdominal aortic aneurysms. J Vasc Surg 32(4):676–683PubMedCrossRefGoogle Scholar
  13. 13.
    Lyden SP, Sternbach Y, Waldman DL, Green RM (2001) Clinical implications of internal iliac artery embolization in endovascular repair of aortoiliac aneurysms. Ann Vasc Surg 15(5):539–543PubMedCrossRefGoogle Scholar
  14. 14.
    Lee CW, Kaufman JA, Fan CM et al (2000) Clinical outcome of internal iliac artery occlusions during endovascular treatment of aortoiliac aneurysmal diseases. J Vasc Interv Radiol 11(5):567–571PubMedCrossRefGoogle Scholar
  15. 15.
    Lee WA, O’Dorisio J, Wolf YG, Hill BB, Fogarty TJ, Zarins CK (2001) Outcome after unilateral hypogastric artery occlusion during endovascular aneurysm repair. J Vasc Surg 33(5):921–926PubMedCrossRefGoogle Scholar
  16. 16.
    Lin PH, Bush RL, Chaikof EL et al (2002) A prospective evaluation of hypogastric artery embolization in endovascular aortoiliac aneurysm repair. J Vasc Surg 36(3):500–506PubMedCrossRefGoogle Scholar
  17. 17.
    Mehta M, Veith FJ, Ohki T et al (2001) Unilateral and bilateral hypogastric artery interruption during aortoiliac aneurysm repair in 154 patients: a relatively innocuous procedure. J Vasc Surg 33(2):S27–S32Google Scholar
  18. 18.
    Mehta M, Veith FJ, Darling RC et al (2004) Effects of bilateral hypogastric artery interruption during endovascular and open aortoiliac aneurysm repair. J Vasc Surg 40(4):698–702PubMedCrossRefGoogle Scholar
  19. 19.
    Rhee RY, Muluk SC, Tzeng E, Missig-Carroll N, Makaroun MS (2002) Can the internal iliac artery be safely covered during endovascular repair of abdominal aortic and iliac artery aneurysms? Ann Vasc Surg 16(1):29–36PubMedCrossRefGoogle Scholar
  20. 20.
    Schoder M, Zaunbauer L, Holzenbein T et al (2001) Internal iliac artery embolization before endovascular repair of abdominal aortic aneurysms: frequency, efficacy, and clinical results. AJR 177(3):599–605PubMedGoogle Scholar
  21. 21.
    Tefera G, Turnipseed WD, Carr SC, Pulfer KA, Hoch JR, Acher CW (2004) Is coil embolization of hypogastric artery necessary during endovascular treatment of aortoiliac aneurysms? Ann Vasc Surg 18(2):143–146PubMedCrossRefGoogle Scholar
  22. 22.
    Wolpert LM, Dittrich KP, Hallisey MJ et al (2001) Hypogastric artery embolization in endovascular abdominal aortic aneurysm repair J Vasc Surg 33(6):1193–1198PubMedCrossRefGoogle Scholar
  23. 23.
    Wyers MC, Schermerhorn ML, Fillinger MF et al (2002) Internal iliac occlusion without coil embolization during endovascular abdominal aortic aneurysm repair. J Vasc Surg 36(6):1138–1145PubMedCrossRefGoogle Scholar
  24. 24.
    Kritpracha B, Comerota AJ (2004) Unilateral lower extremity paralysis after coil embolization of an internal iliac artery aneurysm. J Vasc Surg 40(4):819–21PubMedCrossRefGoogle Scholar
  25. 25.
    Karkos CD, Wood A, Bruce IA, Karkos PD, Baguneid MS, Lambert ME (2004) Erectile dysfunction after open versus angioplasty aortoiliac procedures: a questionnaire survey. Vasc Endovasc Surg 38(2):157–165CrossRefGoogle Scholar
  26. 26.
    Iliopoulos JI, Hemreck AS, Thomas JH, Pierce GE (1989) Haemodynamics of the hypogastric arterial circulation. J Vasc Surg 9:637–642PubMedCrossRefGoogle Scholar
  27. 27.
    Maldonado TS, Rockman CB, Riles E, Douglas D, Adelman MA, Jacobwitz GR, Gagne PJ, Nalbandian MN, Cayne NS, Lamparello PJ, Salzberg SS, Riles TS (2004) Ischaemic complications after endovascular abdominal aortic aneurysm repair. J Vasc Surg 40:703–710PubMedCrossRefGoogle Scholar
  28. 28.
    Lee C, Dougherty M, Calligaro K (2006) Concomitant unilateral internal iliac artery embolization and endovascular infrarenal aortic aneurysm repair. J Vasc Surg 43(5):903–907PubMedCrossRefGoogle Scholar
  29. 29.
    Bratby MJ, Munneke GM, Belli AM, Loosemore TM, Loftus I, Thompson MM, Morgan RA (2007) How safe is bilateral internal iliac artery embolisation prior to EVAR? CardioVasc Interv Radiol (Epub ahead of print)Google Scholar
  30. 30.
    Cynamon J, Lerer D, Veith FJ et al (2000) Hypogastric artery coil embolization prior to endoluminal repair of aneurysms and fistulas: buttock claudication, a recognized but possibly preventable complication. J Vasc Interv Radiol 11(5):573–577PubMedCrossRefGoogle Scholar
  31. 31.
    Parodi JC, Ferreira M (1999) Relocation of the iliac artery bifurcation to facilitate endoluminal treatment of abdominal aortic aneurysms [see Comment]. J Endovasc Surg 6(4):342–347PubMedCrossRefGoogle Scholar
  32. 32.
    Unno N, Inzuka K, Yamamoto N, Sagara D, Suzuki M, Konno H (2006) Preservation of pelvic circulation with hypogastric artery bypass in endovascular repair of abdominal aortic aneurysm with bilateral iliac artery aneurysms. J Vasc Surg 44(6):1170–1175PubMedCrossRefGoogle Scholar
  33. 33.
    Greenberg RK, West K, Pfaff K et al (2006) Beyond the aortic bifurcation:branched endovascular grafts for thoracoabdominal and aortoiliac aneurysms. J Vasc Surg 43(5):879–886PubMedCrossRefGoogle Scholar
  34. 34.
    Haulon S, Greenberg RK, Pfaff K, Francis C, Koussa M, West K (2007) Branched grafting for aortoiliac aneurysms. Eur J Vasc Endovasc Surg 33(5):567–574PubMedCrossRefGoogle Scholar
  35. 35.
    Mell M, Tefera G, Schwarze M, Carr S, Acher C, Hoch J, Turnipseed W (2006) Absence of buttock claudication following stent-graft coverage of the hypogastric artery without coil embolization in endovascular aneurysm repair. J Endovasc Ther 13(3):415–419PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • H. S. Rayt
    • 1
  • M. J. Bown
    • 1
  • K. V. Lambert
    • 1
  • N. G. Fishwick
    • 2
  • M. J. McCarthy
    • 1
  • N. J. M. London
    • 1
  • R. D. Sayers
    • 1
  1. 1.Division of Cardiovascular Sciences, Vascular Surgery Research GroupUniversity of LeicesterLeicesterUK
  2. 2.Department of RadiologyUniversity Hospitals of Leicester NHS TrustLeicesterUK

Personalised recommendations