title: Pelvic ischemia and quality of life scores after interventional occlusion of the hypogastric artery in patients undergoing endovascular aortic aneurysm repair.
abstract: OBJECTIVE
  The aim of this study was to analyze the pelvic ischemic complications and their impact on quality of life after interventional occlusion of the hypogastric artery (IOHA) in patients undergoing endovascular aortic aneurysm repair (EVAR).
  
  
  METHODS
  Between January 2004 and April 2012, 638 consecutive patients with aortoiliac aneurysm treated by EVAR were prospectively registered in two teaching hospitals. We identified all EVAR patients who underwent IOHA. Demographic, clinical, and radiologic data were extracted from electronic databases and patient records as requested. All patients who survived the postoperative period took part in a quality of life survey, the Walking Impairment Questionnaire (WIQ), which included four items: pain, distance, walking speed, and stair climbing. Outcome measures included the 30-day rate of pelvic ischemic complications, the buttock claudication (BC) rate at 30 days and during follow-up, and the comparative WIQ scores between patients with persistent BC, those with regressive BC, and those who never had BC after the IOHA procedure.
  
  
  RESULTS
  A total of 71 patients (97% men; mean age, 76 years ± 7.69) required 75 IOHA procedures. These were deemed proximal in 44 cases and distal in 31, with use of coil embolization in 64%, Amplatzer plug in 24%, or a combination of coils and plugs in 12%. The technical success rate was 100%. Two patients (2.8%) experienced fatal acute pelvic ischemic complications in the postoperative period after EVAR. Another patient died of iliac rupture during EVAR, leading to an operative mortality rate of 4.3%. Eighteen patients (25.3%) suffered BC, among whom 11 cases resolved at a median follow-up of 42 months. Young age (odds ratio, 0.92; 95% confidence interval, 0.85-0.99; P = .03) and distal IOHA (odds ratio, 3.5; 95% confidence interval, 1.01-11.51; P = .04) were independent predictors of BC occurrence. The actuarial rate of persistent BC was 85% at 18 months. The WIQ scores were lower for patients with persistent BC (median score, 35.04; interquartile range, 16.36; P = .001) compared with patients with regressive BC (median score, 76.5; interquartile range, 36.66; P = .02) or those who never experienced BC after the IOHA procedure (median score, 65.34; interquartile range, 10.94; P < .0003).
  
  
  CONCLUSIONS
  Pelvic ischemia associated with IOHA may be severe and lead to fatality after EVAR. Our data show that BC may lead to severe quality of life impairment when it does not regress during follow-up.
authors.affiliation: University of Nice-Sophia-Antipolis, Graduate School of Medicine, Nice, France; Department of Vascular Surgery, Saint Roch Hospital, CHU de Nice, Nice, France.
authors.forename: Elixène
authors.initials: E
authors.lastname: Jean-Baptiste
authors.affiliation: University of Nice-Sophia-Antipolis, Graduate School of Medicine, Nice, France; Department of Vascular Surgery, Saint Roch Hospital, CHU de Nice, Nice, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Brizzi
authors.affiliation: Department of Vascular Surgery, CHU La Timone, Marseille, France.
authors.forename: Michel A
authors.initials: MA
authors.lastname: Bartoli
authors.affiliation: University of Nice-Sophia-Antipolis, Graduate School of Medicine, Nice, France; Department of Vascular Surgery, Saint Roch Hospital, CHU de Nice, Nice, France.
authors.forename: Nirvana
authors.initials: N
authors.lastname: Sadaghianloo
authors.affiliation: University of Nice-Sophia-Antipolis, Graduate School of Medicine, Nice, France; Department of Vascular Radiology, Saint Roch Hospital, CHU de Nice, Nice, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Baqué
authors.affiliation: Department of Vascular Surgery, CHU La Timone, Marseille, France.
authors.forename: Pierre-Edouard
authors.initials: PE
authors.lastname: Magnan
authors.affiliation: University of Nice-Sophia-Antipolis, Graduate School of Medicine, Nice, France; Department of Vascular Surgery, Saint Roch Hospital, CHU de Nice, Nice, France. Electronic address: hassen-khodja.r@chu-nice.fr.
authors.forename: Réda
authors.initials: R
authors.lastname: Hassen-Khodja
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects*; D001014:Aortic Aneurysm / Q000601:surgery*; D002081:Buttocks / Q000098:blood supply; D002908:Chronic Disease; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006801:Humans; D017543:Iliac Aneurysm / Q000601:surgery*; D007383:Intermittent Claudication / Q000209:etiology*; D007511:Ischemia / Q000209:etiology*; D008297:Male; D051346:Mobility Limitation; D018482:Muscle, Skeletal / Q000098:blood supply; D010388:Pelvis / Q000098:blood supply; D011183:Postoperative Complications / Q000401:mortality; D011788:Quality of Life