Unilateral Embolization of the Internal Iliac Artery for Endovascular Aortic Repair Does Not Induce Gluteal Muscle Atrophy

Background: To investigate the effect of unilateral internal iliac artery (IIA) embolization for endovascular aortic repair (EVAR) on gluteal muscle size. Methods: We assessed the gluteal muscle size in 111 consecutive patients who underwent elective EVAR with unilateral IIA embolization (n = 31) or without IIA embolization (n = 80) for abdominal aortic and/or iliac artery aneurysm. The cross-sectional area (CSA) of the gluteus maximus (G(max)) and gluteus medius/minimus (G(med/min)) was measured on computed tomography preoperatively, 6 months postoperatively, and final follow-up. Mean changes in the G(max) and G(med/min) CSA were evaluated using a mixed model analysis of variance. Results: In the patients with embolization, both the Gmax and G(med/min) CSA significantly decreased over time on the embolization and nonembolization sides (P < 0.001); however, embolization did not affect the changes in the G(max) CSA (P = 0.64) and G(med/min) CSA (P = 0.99). In the patients with embolization and those without embolization, both the Gmax and G(med/min) CSA significantly decreased over time (P < 0.001); however, embolization did not affect the changes in the Gmax CSA (P = 0.76) and G(med/min) CSA (P = 0.11). Conclusions: Unilateral IIA embolization was not associated with gluteal muscle atrophy after EVAR. Pre-emptive unilateral IIA embolization for EVAR seems to be an acceptable procedure in terms of maintenance of gluteal muscle size.