Blood oxygen level dependent (BOLD) magnetic resonance imaging technique to predict buttock claudication in patients undergoing endovascular abdominal aorta aneurysm repair (EVAR) with coiling of the internal iliac artery.

20% of patients with an abdominal aneurysm have a concomitant aneurysm in the
iliac arteries. To enable a safe landing zone and prevent endoleaks, coiling of
the internal iliac artery is indicated. This coiling, however, leads to
persistent buttock claudication in 30% of the patients due to a deprived blood
supply. A correct prediction of the chance of buttock claudication can be
incorporated in the treatment to improve patient care. Currently, no predictive
methods for buttock claudication are available. The MR techniques which will be
investigated in this study might be useful predicting buttock claudication due
to coiling of the internal iliac artery.

The goal of this study is to investigate whether BOLD MRI can predict the
occurrence of buttock claudication after coiling of the internal iliac arty.
The BOLD technique will be used to measure blood supply parameters of the
gluteal muscle during and after ischemia of the muscle. The measured parameters
will be correlated with the occurrence of buttock claudication.

Explorative MR imaging study by measuring BOLD-signal after induced ischemia.
The study is divided into two sub-studies. Sub-study 1 investigates the
predictive value of a non-invasive technique to acquire the BOLD-signal and
will be a cross-sectional cohort study. Sub-study 2 investigates the predictive
value of an invasive technique to induce the BOLD-signal and is designed as an
observational prospective cohort study.

The burden and risk of this study for the patient is minimal.
The patients and volunteers in sub-study 1 will receive an MRI scan for a
maximum of 30 minutes, where they are asked to actively contract the gluteal
muscle for 4 times 30 seconds alternated by 15 seconds of rest. Especially
patients with buttock claudication may experience discomfort during the
contraction. They can stop the contraction whenever the discomfort is too high,
afterwards symptoms will diminish. Patients are asked to fill in two
questionnaires to score the extend of buttock claudication

The 10 patients scheduled for EVAR with coiling from sub-study 1 will also
participate in sub-study 2. The artery occlusion and MR scan will be performed
under general anesthesia. The patient will be transferred between two adjacent
rooms, increasing anesthesia time with approximately 45 minutes. Furthermore,
they should also fill the two questionnaires after 3 and 12 months.