title: Unilateral and bilateral hypogastric artery interruption during aortoiliac aneurysm repair in 154 patients: a relatively innocuous procedure.
abstract: OBJECTIVE
  Hypogastric artery (HA) occlusion during aortic aneurysm repair has been associated with considerable morbidity. We analyzed the consequences of interrupting one or both HAs in the standard surgical or endovascular treatment of aortoiliac aneurysms (AIAs).
  
  
  METHODS
  From 1992 to 2000, 154 patients with abdominal aortic aneurysms (n = 66), iliac aneurysms (n = 28), or AIAs (n = 60) required interruption of one (n = 134) or both (n = 20) HAs as part of their endovascular (n = 107) or open repair (n = 47). Endovascular treatment was performed with a variety of industry- or surgeon-made grafts in combination with coil embolization of the HAs. The standard surgical techniques included oversewing or excluding the origins of the HAs and extending the prosthetic graft to the external iliac or femoral artery.
  
  
  RESULTS
  There were no cases of buttock necrosis, ischemic colitis requiring laparotomy, or death when one or both HAs were interrupted. Persistent buttock claudication occurred after 16 (12%) of the unilateral and 2 (11%) of the bilateral HA interruptions. Impotence occurred in 7 (9%) of the unilateral and 2 (13%) of the bilateral HA interruptions. Minor neurologic deficits of the lower extremity were observed in 2 (1.5%) of the patients with unilateral HA interruption.
  
  
  CONCLUSIONS
  Although HA flow should be preserved if possible, selective interruption of one or both HAs can usually be accomplished safely during endovascular and open repair of anatomically challenging AIAs. We believe other comorbid factors such as shock, distal embolization, or the failure to preserve collateral branches from the external iliac and femoral arteries may have contributed to the morbidity in other reports of HA interruption.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA.
authors.forename: M
authors.initials: M
authors.lastname: Mehta
authors.forename: F J
authors.initials: FJ
authors.lastname: Veith
authors.forename: T
authors.initials: T
authors.lastname: Ohki
authors.forename: J
authors.initials: J
authors.lastname: Cynamon
authors.forename: K
authors.initials: K
authors.lastname: Goldstein
authors.forename: W D
authors.initials: WD
authors.lastname: Suggs
authors.forename: R A
authors.initials: RA
authors.lastname: Wain
authors.forename: D W
authors.initials: DW
authors.lastname: Chang
authors.forename: S G
authors.initials: SG
authors.lastname: Friedman
authors.forename: L A
authors.initials: LA
authors.lastname: Scher
authors.forename: E C
authors.initials: EC
authors.lastname: Lipsitz
mesh_terms: D000368:Aged; D000792:Angiography; D017130:Angioplasty / Q000009:adverse effects* / Q000379:methods*; D001014:Aortic Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods*; D003092:Colitis / Q000209:etiology; D015897:Comorbidity; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017543:Iliac Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D007083:Iliac Artery / Q000601:surgery*; D018783:Impotence, Vasculogenic / Q000209:etiology; D007383:Intermittent Claudication / Q000209:etiology; D008297:Male; D009017:Morbidity; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome