A Case of Extensive Gluteal Muscle Necrosis after Internal Iliac Artery Embolization in Endovascular Aortoiliac Aneurysm Repair

Abstract

Endovascular abdominal aneurysm repair (EVAR) has become widespread through the world. However, coil embolization of the internal iliac artery (IIA) can lead to pelvic ischemia with hip and buttock claudication, colon ischemia, and gluteal muscle ischemia. A 86-year-old man received EVAR and unilateral IIA coil embolization. Postoperatively, he had a serious ischemic complication with gluteal muscle and skin necrosis. He underwent several debridement, and vaccumed assisted closure (VAC) was applied. Furthermore, he had ilium-osteomyelitis and intravenous antibiotics administration was continued three weeks. After that, ilium-osteomyelitis was healed, and gluteal muscle necrosis resulted in significant improvement. He discharged 219 days after surgery. Preoperatively, we should examine chronic pelvic ischemia that may impede development of new pelvic collaterals.