Document Detail

Preliminary embolization of the hypogastric artery to expand the applicability of endovascular aneurysm repair.
MedLine Citation:
PMID:  21314360     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To evaluate the efficacy and safety of preliminary hypogastric artery (HA) embolization prior to endovascular aneurysm repair (EVAR).
METHODS: A retrospective review was conducted of all 101 consecutive patients (91 men; mean age 73.4 ± 8.7 years) who underwent preliminary embolization of 133 HAs ∼4 to 6 weeks prior to EVAR from January 2005 to August 2009. Fourteen patients with 19 HAs were treated using coils, while 87 patients were treated with Amplatzer Vascular Plugs (AVP) in 114 HAs. All the patients were evaluated before discharge; at 1, 3, and 6 months; and annually thereafter to evaluate the clinical symptoms, potential endoleaks, and the aneurysm size.
RESULTS: In the coil group, complete occlusion was achieved in 16 (84.2%) of 19 procedures. There were no acute pelvic ischemic symptoms after HA embolization or EVAR. Five (35.7%) patients had buttock claudication and 2 (16.7%) of 12 men experienced new erectile dysfunction after embolization. At a mean 42.2-month follow-up (range 14-58), 3 (21.4%) patients had a type II leak via retrograde flow in the HA without aneurysm growth and were under observation. In the AVP group, all 114 HAs in 87 patients were successfully occluded; there was no device dislodgment or acute pelvic or limb ischemia observed. Buttock claudication and new sexual dysfunction developed in 12 (13.8%) patients and 4 (5.1%) of 79 men after the procedure, respectively. During a mean 26.4-month follow-up (range 4-54), 2 (2.3%) patients developed distal type I endoleaks after EVAR, but angiography confirmed that neither of the endoleaks was related to the vessel embolized with the AVP. Comparing the outcomes of the treatment groups, the AVP was placed with fewer intraoperative complications (p = 0.013) and more complete occlusion (p = 0.01) than coil embolization. The rate of buttock claudication was lower in the AVP group (p = 0.042).
CONCLUSION: Hypogastric artery embolization prior to EVAR is safe and effective. In our experience, the AVP affords easier and more precise placement and provides more complete occlusion, with fewer intraoperative and postoperative ischemic complications than coil embolization.
Ziheng Wu; Dieter Raithel; Wolfgang Ritter; Lefeng Qu
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists     Volume:  18     ISSN:  1545-1550     ISO Abbreviation:  J. Endovasc. Ther.     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-02-14     Completed Date:  2011-06-07     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  100896915     Medline TA:  J Endovasc Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  114-20     Citation Subset:  IM    
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MeSH Terms
Aged, 80 and over
Aneurysm / physiopathology,  radiography,  surgery,  therapy*
Aortography / methods
Blood Vessel Prosthesis Implantation* / adverse effects
Buttocks / blood supply
Chi-Square Distribution
Embolization, Therapeutic* / adverse effects,  instrumentation
Endoleak / etiology
Endovascular Procedures* / adverse effects
Erectile Dysfunction / etiology
Ischemia / etiology,  physiopathology,  prevention & control*
Middle Aged
Pelvis / blood supply*
Regional Blood Flow
Retrospective Studies
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Comment In:
J Endovasc Ther. 2011 Feb;18(1):121-2   [PMID:  21314361 ]

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