Buttock claudication

A spectrum of end-organ ischemic complications can occur with embolotherapy. Bowel infarction can complicate splanchnic embolization targeting bleeding or could result from inadvertent non-target embolization from an upstream source [88]. Gallbladder infarction or bile duct necrosis can complicate hepatic artery embolization or che-moembolization [89, 90]. Splenic abscess and overwhelming sepsis can occurs following splenic embolization [91]. Skin necrosis and nerve injury have been reported as a result of ethanol embolization of vascular malformations [53, 54]. Buttock muscular necrosis, buttock claudication and sexual dysfunction can occur as a result of internal iliac branch embolization, especially when distal or bilateral [92-95]. 

Claudication is a transient condition in the majority of these patients and tends to improve or resolve over time. Thigh and buttock claudication can last anywhere from a few weeks to few years. Resolution occurs in 41%-77% of patients depending on the patients level of activity and status of collateral circulation [1,13,19,20]. 

Cynamon J, Lerer D, Veith F et al. (2000) Hypogastric artery coil embolization prior to endoluminal repair of aneurysms and fistulas buttock claudication, a recognized but possibly preventable complication. J Vase Interv radiol 11 543-545... 

Embolization of the IIA or its branches (lumbosacral or lateral sacral arteries) may cause ischemia of the lumbosacral nerve roots. The pain associated with this condition resembles nerve root compression and can be mistaken for buttock and thigh claudication. The pain and discomfort is usually more intense, lasts longer, and may be associated with ipsilateral weakness. This condition can be precipitated by unilateral IIA embolization and should be considered in patients with persistent symptoms. 

Although the incidence of serious complications such as colonic, lumbosacral plexus, or buttock necrosis is low after IIA embolization, the incidence of claudication and sexual dysfunction is high enough to warrant preservation of the IIA circulation if possible. In final analysis, the decision whether to embolize an IIA or not should be weighed against the potential risks and benefits of the other therapeutic alternatives. The risk of development of such symptoms as claudication or sexual dysfunction may outweigh the hazards of IIA revascularization or aneurysm rupture and death if no action is taken. 

Deflnition of positive classification requires all of the following responses Y es to (1), No to (2), Yes to (4). If these criteria are fulfilled, a definite claudicant is one who indicates pain in the calf, regardless of whether pain is also marked in other sites a diagnosis of atypical claudication is made if pain is indicated in the thigh or buttock, in the absence of any calf pain. Subjects should not be considered to have claudication if pain is indicated in the hamstrings, feet, shins, joints, or appears to radiate, in the absence of any pain in the calf (18). 

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