Handbook of Endovascular Interventions by Amit Kumar & Kenneth Ouriel

Author:Amit Kumar & Kenneth Ouriel
Language: eng
Format: epub
Publisher: Springer New York, New York, NY

(e) Pelvic Ischemia: Occlusion of one or both internal iliac arteries may lead to pelvic ischemia. Buttock claudication is the most common consequence; at approximately 30% of patients with bilateral hypogastric artery occlusion. 50% of these patients’ symptoms will usually resolve within 6 months, other patients’ symptoms may improve. Other potential consequences of internal iliac artery occlusion are erectile dysfunction, buttock necrosis, ischemic colitis, colon necrosis, and spinal ischemia. Previous colonic surgery where the SMA does not provide collaterals to the colon and diseased profunda femoris artery with decreased pelvic collaterals are some of the risk factors. At our institution we embolize one side, wait 2 weeks looking for signs of ischemia of pelvic ischemia and then wait another 2 weeks prior to EVAR. In specific cases we perform routine sigmoidoscopy the day after surgery.

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