Effects of bilateral hypogastric artery interruption during endovascular and open aortoiliac aneurysm repair

• Published in: Journal of vascular surgery 2004-10, Vol.40 (4), p.698-702
• Main Authors: Mehta, Manish, Veith, Frank J., Darling, R. Clement, Roddy, Sean P., Ohki, Takao, Lipsitz, Evan C., Paty, Philip S.K., Kreienberg, Paul B., Ozsvath, Kathleen J., Chang, Benjamin B., Shah, Dhiraj M.
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty - adverse effects; Angioplasty - methods; Aortic Aneurysm - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - methods; Cardiology. Vascular system; Collateral Circulation - physiology; Diseases of the aorta; Female; General and cellular metabolism. Vitamins; Humans; Iliac Artery - surgery; Ischemia - etiology; Ischemia - prevention & control; Ligation - adverse effects; Male; Medical sciences; Pelvis - blood supply; Pharmacology. Drug treatments; Stents; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2004.07.036

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. 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). 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. 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.