Critical Gluteus Ischemia Immediately after Internal Iliac Artery Embolization

Abstract

Internal iliac artery (IIA) embolization is often performed in endovascular aorto-iliac aneurysm repair to prevent type II endoleak, which can be associated with pelvic ischemia. An 82-year-old man presented with abdominal aortic aneurysm and bilateral common iliac artery aneurysms on abdominal computed tomography (CT). He underwent right IIA occlusion before endovascular aortic repair (EVAR), and EVAR and left IIA embolization were performed in 7 days. Postoperatively, he had severe left gluteal muscle pain at rest and immediate severe cyanosis. We performed an emergency left external-internal iliac artery bypass using a knitted dacron prosthesis. After surgery, the pain at rest and cyanosis resolved. A postoperative abdominal CT revealed no endoleak and the external-internal iliac artery bypass was patent without any problems. If severe pelvic ischemia is caused by the EVAR with IIA embolization, iliac artery revascularization should be performed as soon as possible.