Sam Heye1, André Nevelsteen, Geert Maleux. 1. Centre for Vascular Diseases, Section of Interventional Radiology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium. sam.heye@uz.kuleuven.ac.be
Abstract
PURPOSE: To evaluate whether the presence of type 2 endoleak after internal iliac artery (IIA) coil embolization in patients with residual antegrade flow through the coils is more frequent than in patients who presented with total occlusion of the IIA after embolization. MATERIALS AND METHODS: Records were reviewed of 45 patients who underwent unilateral (n = 37) or bilateral (n = 8) IIA coil embolization between 1998 and 2004 for endovascular repair of aortoiliac aneurysms (n = 32), iliac artery aneurysms (n = 12), pseudoaneurysm (n = 1), or distal type 1 endoleak after placement of an aortoiliac stent-graft (n = 8). A total of 53 IIAs were embolized by means of coils and/or microcoils. Computed tomography (CT) was used for follow-up in 40 patients, angiography was used in three, and color Doppler ultrasonography was used in three. RESULTS: At the end of the embolization procedure, 23 IIAs were occluded and 30 IIAs demonstrated residual antegrade flow through the coils. Control CT demonstrated two type 2 endoleaks after endovascular stent-graft placement resulting from retrograde blood flow into the left IIA main branch via a patent iliolumbar artery. One of these two patients showed residual antegrade flow through the coils at the end of the IIA embolization procedure, and the other patient underwent complete coil embolization of the ostia of the anterior and posterior division but not of the main trunk of an aneurysmal IIA. CONCLUSION: IIA coil embolization with residual antegrade flow through the coils causes no greater incidence of type 2 endoleak after aortoiliac or iliac stent-graft placement. However, care must be taken in case of a proximal postostial origin of the iliolumbar artery on the IIA, which may cause type 2 endoleak if not embolized.
PURPOSE: To evaluate whether the presence of type 2 endoleak after internal iliac artery (IIA) coil embolization in patients with residual antegrade flow through the coils is more frequent than in patients who presented with total occlusion of the IIA after embolization. MATERIALS AND METHODS: Records were reviewed of 45 patients who underwent unilateral (n = 37) or bilateral (n = 8) IIA coil embolization between 1998 and 2004 for endovascular repair of aortoiliac aneurysms (n = 32), iliac artery aneurysms (n = 12), pseudoaneurysm (n = 1), or distal type 1 endoleak after placement of an aortoiliac stent-graft (n = 8). A total of 53 IIAs were embolized by means of coils and/or microcoils. Computed tomography (CT) was used for follow-up in 40 patients, angiography was used in three, and color Doppler ultrasonography was used in three. RESULTS: At the end of the embolization procedure, 23 IIAs were occluded and 30 IIAs demonstrated residual antegrade flow through the coils. Control CT demonstrated two type 2 endoleaks after endovascular stent-graft placement resulting from retrograde blood flow into the left IIA main branch via a patent iliolumbar artery. One of these two patients showed residual antegrade flow through the coils at the end of the IIA embolization procedure, and the other patient underwent complete coil embolization of the ostia of the anterior and posterior division but not of the main trunk of an aneurysmal IIA. CONCLUSION: IIA coil embolization with residual antegrade flow through the coils causes no greater incidence of type 2 endoleak after aortoiliac or iliac stent-graft placement. However, care must be taken in case of a proximal postostial origin of the iliolumbar artery on the IIA, which may cause type 2 endoleak if not embolized.