Original title: Comparison of outcomes with coils versus vascular plug embolization of the internal iliac artery for endovascular aortoiliac aneurysm repair. Reference: Evan J. Ryer et al. J Vasc Surg 2012;56:1239-45

20% of patients with abdominal aortic aneurysm (AAA) present a compromise of the common distal iliac artery, these often require the stent to cover up to the external iliac. Retrograde flow through the internal iliac artery can pressurize the bag and generate a type II endoleak which requires embolization. 

Both coils and the Amplatzer vascular plug are useful for embolization but no studies have compared them. 

This study included 53 consecutive patients, analyzed retrospectively, who underwent embolization of the internal iliac artery. 29 patients received coils, (Cook Medical Inc, Bloomington, Ind), and 28 an Amplatzer vascular plug (AGA Medical Corporation). 63% underwent embolization prior to the stent implantation procedure. Coils were used per patient 5.8 versus 1.1 plug. Fluoroscopy time was significantly lower with the use of a plug, (coil 32.6 ± 14.6 min vs. plug 14.4 ± 8.6 min p = 0.002). No expected embolization occurred in 2 patients from the coil group, these could be extracted as endovascular uncomplicated. 

In follow-up 39.3 ± 24.2 months, there were three type II endoleaks in the plug group. None of these endoleaks were related to the internal iliac artery and were not associated with bag growth. Persistent buttock claudication occurred in 13.8% (n = 4) of the coil group and in 14.3% of the plug group (n = 4). There was no colonic or pelvic ischemia in any patient. In the cost analysis the authors found no differences between the groups.

Conclusion 

Both devices were equally effective and safe for internal iliac artery embolization in the context of stent implantation with a shorter procedure and fluoroscopy using a plug.

Editorial Comment:

This study was not randomized so the choice of the device may have been influenced by the anatomical complexity. It is also important to consider the costs where we work, because if this analysis was performed in Argentina for example, the coils would be significantly less expensive. It is necessary to counterbalance the costs with a shorter procedure and fluoroscopy.

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