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Ghoneim et al. Vessel Plus 2020;4:38 Vessel Plus
DOI: 10.20517/2574-1209.2020.35

Original Article Open Access

Internal iliac artery sacrifice during endovascular
abdominal aortic aneurysm repair

Baker Ghoneim , Patrick Canning , Yogesh Acharya , Niamh Hynes , Wael Tawfick , Sherif Sultan 1,3
1,2
1
3
1
1,2
1 Western Vascular Institute, Department of Vascular and Endovascular Surgery, Galway University Hospital, National University
of Ireland, Galway H91 YR71, Ireland.
2 Department of Vascular Surgery, Faculty of Medicine, Cairo University, Cairo 12613, Egypt.
3 Galway Clinic, Department of Vascular and Endovascular Surgery, Doughiska, Galway H91HHT0, Ireland.
Correspondence to: Prof. Sherif Sultan, MCh, MD, FRCS, FACS, PhD. Department of Vascular and Endovascular Surgery, Western
Vascular Institute, National University of Ireland, Newcastle Road, Galway, Ireland H91 YR71.
E-mail: sherif.sultan@hse.ie; sherif.sultan@nuigalway.ie. ORCID: 0000-0001-8767-4929.
How to cite this article: Ghoneim B, Canning P, Acharya Y, Hynes N, Tawfick W, Sultan S. Internal iliac artery sacrifice during
endovascular abdominal aortic aneurysm repair. Vessel Plus 2020;4:38. http://dx.doi.org/10.20517/2574-1209.2020.35

Received: 28 Jul 2020 First Decision: 8 Aug 2020 Revised: 3 Nov 2020 Accepted: 17 Nov 2020 Published: 10 Dec 2020

Academic Editor: Junmin Zhu Copy Editor: Cai-Hong Wang Production Editor: Jing Yu
Received: First Decision: Revised: Accepted: Published: x
Abstract
Science Editor: Copy Editor: Production Editor: Jing Yu
Aim: We aimed to assess the clinical outcomes of the internal iliac artery (IIA) coverage during endovascular
abdominal aortic aneurysm repair (EVAR).

Methods: A retrospective observational study was conducted in patients managed with EVAR for the aorto-iliac
aneurysmal disease. The IIA was sacrificed by extension of the stent-graft into the external iliac artery in the
absence of the distal landing zone, while it was preserved if the landing zone was available.

Results: From 2002 to 2018, 540 patients underwent EVAR for aorto-iliac aneurysmal disease in our center. Sixty-
five (12.04%, n = 65/540) had iliac aneurysm extension. Among these 65 cases, the IIA was not covered in 32
patients (IIA salvage/spared group), while they were covered in 33 patients (IIA sacrifice group). The IIA sacrifice
group consisted of 25 unilateral and 8 bilateral coverages. There was 100% technical success and no 30-day
mortality in both groups. The IIA sacrifice group had more postoperative complications in general when compared
to the IIA salvage group, but they were not significant (P < 0.05). There were one patient with buttock claudication
(P = 1.000) with bilateral IIA coverage, two cases of lower limb microembolization (P = 0.492) and one case of
erectile dysfunction (P = 1.000) in IIA sacrifice group, while they were not seen in IIA salvage group. There was no
ruptured iliac access, device-related malfunction, spinal cord ischemia or bowel ischemia in either group.

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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