Bilateral hypogastric artery occlusion in endovascular repair of abdominal aortic aneurysms and its clinical significance.
OBJECTIVE
Endovascular treatment of aortoiliac aneurysms near or involving the hypogastric artery (HGA) requires HGA occlusion before endografting to avoid retrograde filling of the aneurysm. The purpose of this study is to evaluate clinical outcomes of bilateral HGA occlusion and determine if benefits gained by endovascular aneurysm repair (EVAR) outweigh the morbidity associated with the procedure.


METHODS
Between 1999 and 2004, 128 patients with abdominal aortic aneurysm (AAA) were treated with bifurcated endograft placement. Bilateral coverage or embolization of HGAs was performed in 14 patients (10.9%). Embolization was achieved by deployment of coils and coverage was accomplished by extending the endoprosthesis into the external iliac artery. Clinical follow-up and computed tomographic angiography were performed at 1, 3, 6, 9, and 12 months and annually thereafter to detect potential aneurysm growth and endoleaks.


RESULTS
During follow-up (range, 1-72 months), buttock claudication was noted in four patients (28.6%), including unilateral claudication in two and bilateral claudication in two. One patient experienced claudication longer than 12 months, which resolved within 18 months. De novo erectile dysfunction was seen in one patient, and pelvic ischemia was not found in any patient. There was no evidence of endoleak, aneurysm enlargement, or death associated with HGA occlusion.


CONCLUSIONS
In our series, complications of bilateral HGA occlusion before EVAR were moderate and resolved over time. The benefits gained from EVAR outweigh the clinical problems caused by bilateral HGA occlusion, as there are no technical complications added to the EVAR procedure.
Department of Endovascular Therapy, Hospiten Rambla, Rambla General Franco 115, 38001 Santa Cruz de Tenerife, Spain. tobiaszander@gmx.de
Tobias
T
Zander
Sebastian
S
Baldi
Martin
M
Rabellino
Roman
R
Rostagno
Baltasar
B
Isaza
Rafael
R
Llorens
Jose M
JM
Carreira
Manuel
M
Maynar
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D017544:Aortic Aneurysm, Abdominal / Q000503:physiopathology / Q000601:surgery*; D001783:Blood Flow Velocity; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D002081:Buttocks / Q000098:blood supply; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006801:Humans; D017543:Iliac Aneurysm / Q000503:physiopathology / Q000601:surgery*; D007383:Intermittent Claudication / Q000209:etiology / Q000503:physiopathology; D007511:Ischemia / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000098:blood supply; D010413:Penis / Q000098:blood supply; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D015641:Radiography, Interventional; D013270:Stomach / Q000098:blood supply*; D014057:Tomography, X-Ray Computed; D014654:Vascular Patency