Print this pageOutcomes of Iatrogenic Iliac Artery Rupture During Endovascular AAA Repair
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Eugene Palchik, MD, Andrew M. Bakken, MD, Karl A. Illig, MD, Wael E. Saad, MD, David L. Waldman, MD, PhD, Mark G. Davies, MD, PhD.
University of Rochester, Rochester, NY, USA.
Objectives: Intra-operative rupture of the iliac artery is a serious complication of endovascular aneurysm repair (EVAR). This study reviews our experience with this complication.
Methods: All cases of iliac artery rupture during EVAR between 1996 and 2006 were reviewed for presentation, treatment strategies and outcomes.
Results: Iliac artery rupture complicated 16 (4%) of 362 EVAR’s performed. Thirteen (81%) common and 3(19%) external iliac arteries were ruptured. Hypotension (SBP < 90 mmHg) was present in 10 (63%) cases. In 5 (31%) early cases, open bypass was performed. 11 subsequent cases (69%) were repaired endovascularly. In 6 of 11 cases, hypotension and extravasation were controlled by intravascular balloon occlusion followed by ipsilateral limb extension. In 5 hemodynamically stable patients, iliac limb extension covering the rupture was used. There were no intra-operative deaths. There were 4 (25%) early ICU deaths (< 3 days post op). All had had both hypogastric arteries sacrificed; 3 died from complications of pelvic ischemia and one died from multiple organ failure. One patient died within 30 days from unrelated causes. Seven of 12 (58%) surviving patients developed post-operative complications unrelated to pelvic ischemia.
Conclusions:Rupture of an iliac artery has a relatively low incidence but carries a high mortality and morbidity. In our practice, endoluminal management has evolved as the primary strategy for these ruptures. Importantly, sacrifice of both hypogastric arteries is associated with mortality from pelvic ischemia and must be avoided or counteracted at the time of intervention.
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