In Reply to: Re: Case 497_06 -- Coil embolization of symptomatic right iliac artery aneurysm posted by Bob Vogelzang on April 21, 1997 at 19:39:09:
We've used gadolinium as an alternative contrast in 28 cases in which
we've tracked outcome-reactions, creatinine elevation, etc. It works well and has caused
no untoward events. We've used it for venousd studies, TIPS, pulmonary stents, arteriograms, etc.
I typically inject volumes similar to those used for standard DSA.
I would echo the same reservations re: need for absolute and total embolization
of the internal iliac (and its distal branches) because of the risk of backflow and possible
rupture. Our most dramatic case was published: an AVF in which a colleague embolized the internal iliac
to stasis, yet retrograde flow persisted, leading to massive persistent hemolysis. It took a bit of work to
achieve thrombosis (though this was a high flow situation). We stent grafted him 1.5 years ago and he
remains asymptomatic-no AVF, normal PVRs.
Jacob Cynamon also used a stent graft/ embo to exclude and internal iliac artery
aneurysm.
graft and embo to exclude an iliac aneurysm.
I personally would have considered/tried an iliac stent graft in this case, rather
than embolization and crossover surgical graft.
Ziv Haskal, M.D.
Duszak R Jr. Haskal ZJ. Sacks D. Coffey JA. Massive hemolysis: a rare complication
of transcatheter coil embolization. JVIR. 7(4):603-6, 1996
Cynamon J. Marin ML. Veith FJ. Bakal CW. Silberzweig JE. Rozenblit A. Wahl SI.
Endovascular repair of an internal iliac artery aneurysm with use of a stented graft and
embolization coils.JVIR (4):509-12, 1995