Effects of bilateral hypogastric artery interruption during endovascular and open aortoiliac aneurysm repair.
OBJECTIVE
Hypogastric artery interruption is sometimes required during aortoiliac aneurysm repair. We have not experienced some of the life-threatening complications of pelvic ischemia reported by others. Therefore we analyzed our experience to identify factors that help minimize pelvic ischemia with unilateral and bilateral hypogastric artery interruption.


METHODS
From 1995 to 2003, 48 patients with aortoiliac aneurysm required interruption of both hypogastric arteries as part of endovascular (n = 32) or open surgical (n = 16) repair. During endovascular aneurysm repair coils were placed at the origin of the hypogastric arteries, and bilateral hypogastric artery interruptions were staged at 1 to 2 weeks when possible. Open surgery necessitated oversewing or excluding the origins of the hypogastric arteries and extending the prosthetic graft to the external iliac or femoral artery. Collateral branches from the external iliac and femoral arteries were preserved, and patients received systemic heparinization (50 units/kg).


RESULTS
There was no buttock necrosis, ischemic colitis requiring colon resection, or death with the bilateral hypogastric artery interruption. Initially buttock claudication developed in 20 patients (42%), but persisted in only 7 patients (15%) at 1 year. New onset of impotence occurred in 4 of 28 patients (14%), and there were no neurologic deficits.


CONCLUSIONS
Bilateral hypogastric artery interruptions can be accomplished with limited morbidity. When hypogastric artery interruption is needed during endovascular aneurysm repair, certain principles help minimize pelvic ischemia. These include hypogastric artery interruption at its origin to preserve the pelvic collateral vessels, staging bilateral hypogastric artery interruptions when possible, preserving collateral branches from the femoral and external iliac arteries, and providing adequate heparinization of the patient during these procedures.
Institute for Vascular Health and Disease, Albany Medical Center, New York 12208, USA. MehtaM@albanyvascular.com
Manish
M
Mehta
Frank J
FJ
Veith
R Clement
RC
Darling
Sean P
SP
Roddy
Takao
T
Ohki
Evan C
EC
Lipsitz
Philip S K
PS
Paty
Paul B
PB
Kreienberg
Kathleen J
KJ
Ozsvath
Benjamin B
BB
Chang
Dhiraj M
DM
Shah
D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000379:methods*; D001014:Aortic Aneurysm / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D003097:Collateral Circulation / Q000502:physiology; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D007511:Ischemia / Q000209:etiology / Q000517:prevention & control*; D008026:Ligation / Q000009:adverse effects; D008297:Male; D010388:Pelvis / Q000098:blood supply*; D015607:Stents