management of internal iliac artery during aorto-iliac
TRANSCRIPT
Management of Internal Iliac Artery during Aorto-Iliac Reconstruction
Mohan AdiseshiahEndovascular Unit
University College Hospital
The Challenge of the iliac landing site
Aneurysmal common iliac artery:-
Unilateralbilateral
Iliac Artery Challenge
The internal iliac artery;-
UnilateralBilateral
Internal Iliac Aneurysm
Rare 7/440 (1.6 %) with concommittant AAA
3/440 (0.7%) not associated with AAA
(ZimmerAnn.Vasc.Surg. 1999;13:515-9)
Common Iliac Aneurysm
Of 154 AAAs:-No iliac involvement - 60 (42.9%)Aorto-iliac aneurysm – 60 (39.0%)Iliac Artery aneurysm without obvious AAA -
28 (18.2%)Mehta J Vasc Surg.2001; 33:S27-32
Problems associated with internal iliac artery during and after EVAR
Consequences of covering the Internal Iliac Artery
The internal iliac after EVAR when left uncovered
Consequences of covering the Internal Iliac Artery
Buttock claudicationColonic ischaemia?Impotence?Sacral soreLumbosacral plexus ischaemiaSpinal cord ischaemia
Buttock Claudication
Common (28%) and disabling
Can subside after a period
(Usually untreated)
Colonic Ischaemia
Coverage of inferior mesenteric artery by endograftSuperior mesenteric
artery insufficiencyInternal iliac artery
coverageHypotensive episodes
Impotence
No firm figures for incidenceSubstantial erectile dysfuction before surgery
(Prinssen M, et al J Endovasc Ther. 2004 Dec;11(6):613-20.)
Sacral Sore
Usually in bed ridden patients
No data on the incidence of internal iliac cover.
Spinal and plexus ischaemia
Extremely rare:-<0.5% of all EVARNumber of Internal Iliacs covered unknown
Late problems associated with the Internal Iliac Artery: (Case
Report)
White, male, 70 years
6 cm infrarenal AAA - with normal iliacs
Case Report
1996 AAA repaired-
UCH homemade device - pre-expanded PTFE fixed with Palmaz stents. Contralateral
proximal common iliac coiled.
Case Report
2002 -6 years post-op :-
Right internal and common iliac distal to coils become aneurysmal
Case Report
Common iliac and internal aneurysms coiled + ligature external iliac :-
open + endovascular surgery
Conclusion
The internal iliac rarely causes serious problems during or after EVARButtock claudication is the commonest
problemColon ischaemia, spinal cord and nerve
plexus ischaemia occurs in < 1% of casesLate aneurysm formation is also rare