Internal iliac coils

In the absence of arterial spasm, embolization with Gelfoam pledge of both uterine and internal iliac arteries is always performed in order to obtain a bilateral proximal and distal embolization to prevent rebleeding. Even with Gelfoam pledge, we always use large-cut sizes to prevent embolization that is too distal. Embolization with coils is not per-... 

Clinical outcomes appear similar when the internal iliac veins are routinely occluded. Venbrux et al. (1999) followed 56 women for a mean of 22.1 months after embolization with coils and sodium morulate [36]. The internal iliac veins were also occluded in 43 of 56 patients at a separate procedure 3 to 10 weeks after ovarian vein embolization. The technical success rate was 100%. Three patients developed recurrent varices, two of whom were treated with repeat embolization. Using visual analogue scales to measure pain, a mean 65% decrease in VAS score was recorded. Two patients (4%) reported no change in their symptoms, no patients had worsening of their pain after embolization. 

S.Criado EJ, Wilson EP, Velazquez OC et al. (2000) Safety of coil embolization of the internal iliac artery in endovascular grafting of abdominal aortic aneurysms. J Vase Surg 32 684-688... 

Heye S, Nevelsteen A, Maleux G (2005) Internal iliac artery coil embolization in the prevention of potential type-2 endoleak after endovascular repair of abdominal aortic... 

For example, in a patient with a hypervascular carcinoma of the uterine cervix as defined by angiography through catheters placed in the main trunk of the internal iliac arteries, the radionuclide flow study can be utilized to demonstrate the flow distribution almost exclusively to the true pelvis. Therefore, the position of the catheters would be adequate and more selective catheterization would not be necessary. On the other hand, in a patient with a hypovascular tumor (most squamous cell carcinomas of the cervix are relatively hypovascular), catheter placement into the internal iliac artery may not only infuse the true pelvis, but may also infuse the buttocks. Embolization of the superior and inferior gluteal arteries with coils or segments of Gelfoam or both can be used to prevent the infusion of the buttocks and redistribute the chemotherapy to the true pelvis. This may result in increased pudendal flow and potentially increase local toxicity. 

Long reverse curve catheter allows for a very fast way to access the internal iliacs and to perform subselective embolization quickly with large pieces of Gelfoam or large coils... 

Fig. 15.2a-c. Embolization of IIA before aortic stent graft implantation (courtesy of Dr Luc Stockx). a Right common iliac angiogram demonstrating the internal and external iliac arteries. b,c Coil embolization of the proximal llA. Note the extension of the aneurysm to the level of iliac bifurcation... 

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