Effect Of Reconstruction Of Internal Iliac Artery On The Complications Of Pelvic Ischemia During Endovascular Treatment Of Aortoiliac Aneurysm

Objective: In endovascular aortic repair(EVAR)of aortoiliac aneurysm,the reconstruction or preservation of internal iliac artery is often involved.The purpose of this study is to explore the effect of IIA(Internal iliac artery)reconstruction/reservation and non-reservation on pelvic ischemic complications in EVAR of aortoiliac aneurysm.Methods: From January 2012 to December 2021,108 patients with abdominal aortic aneurysm and iliac aneurysm who received EVAR treatment were included.In the form of follow-up telephone,explore the difference of pelvic ischemic complications between patients with reconstructed or preserved IIA and those without reconstruction.Results: A total of 108 patients(73.3 ± 9.5 years old,89.8% male)were included in this study and were divided into IIA reconstruction group and IIA non-reconstruction group.During the follow-up,16.7%(18/108)of them died(12 in the reconstruction/preservation group of internal iliac artery and 6 in the non-reconstruction/preservation group),of which 14.8%(16/108)were lost(11 in the reconstruction/preservation group of internal iliac artery and 5 in the non-reconstruction/preservation group).18.5%(17/92)of patients had complications of pelvic ischemia,16.3%(15/92)had gluteal muscle claudication(IIA reconstruction/preservation group vs IIA non-reconstruction/ preservation group:10.1%(7/69)vs 34.8%(8/23),P=0.015),11.6%(8/69)had erectile dysfunction(IIA reconstruction/preservation group vs IIA non-reconstruction/ preservation group: 5.7%(3/53)vs 31.3%(5/16),P=0.018),Six of them had both gluteal muscle claudication and ischemic erectile dysfunction.The results of multifactor analysis of complications of gluteal muscle claudication showed that age>75 years old(OR(95% CI): 3.936(1.055-14.686),P=0.041),internal iliac artery not reconstructed/preserved(OR(95% CI): 0.193(0.053-0.707),P=0.013)and preoperative erythrocyte count(OR(95% CI): 3.631(1.069-12.337),P=0.039)were risk factors for gluteal muscle claudication.The results of multifactor analysis of the complications of ischemic erectile dysfunction showed that age>75 years old(OR(95% CI): 5.946(1.069-33.079),P=0.042),internal iliac artery not reconstructed(OR(95% CI): 0.108(0.019-0.597),P=0.011)and LDH(OR(95% CI):1.004(1-1.007),P=0.027)were risk factors of ischemic erectile dysfunction.Conclusion: In endovascular aortic repair(EVAR)of aortoiliac aneurysm,reconstruction/preservation of one internal iliac artery can prevent the occurrence of pelvic ischemia complications.