Evaluation of Prophylactic Internal Iliac Artery Embolization for Endovascular Aortic Aneurysm Repair using Amplatzer Vascular Plug

Purpose: To assess the efficacy of Amplatzer vascular plug (AVP) for prophylactic internal iliac artery embolization during endovascular aortic aneurysm repair (EVAR) by comparing the cases with and without using AVP. Subjects: A total of 147 embolizations were performed at our hospital from September 2009 to January 2024 during EVAR procedures with preventive internal iliac artery embolization. There were 100 male and 23 female patients. Among the embolizations, 125 were simultaneous and 22 were staged. Bilateral embolizations were performed in 24 cases. Methods: We evaluated the success rate and details of embolization in all cases, changes in procedures before and after the introduction of AVP, comparison between the coil group and the AVP group, retrospective evaluation of adverse events, time and costs required for embolization. Results: The success rate of embolization procedures was 100%. Before the introduction of AVP, all 46 embolization procedures were performed using metal coils, but after the introduction of AVP, embolization with AVP was possible in 92 of 101 embolization procedures (91%). There was no significant difference between the two groups in terms of type 2 endoleaks and intraoperative vascular injuries. The AVP group showed significantly lower rates of buttock claudication (P=0.028), higher cumulative improvement rates in buttock claudication (P=0.0385), shorter procedural times (coil 105.1 ± 13.5 minutes vs AVP 50.4 ± 4.9 minutes P=0.003), and lower costs for embolization procedures (coil ¥309,445 ± ¥51,240 vs AVP ¥189,131 ± ¥13,476 P=0.000). Conclusion: Embolization using AVP has a high success rate, and may reduce the frequency of buttock claudication, improve the cumulative improvement rate, shorten procedure times, and reduce the costs of embolization.