Unilateral and bilateral hypogastric artery interruption during aortoiliac aneurysm repair in 154 patients: A relatively innocuous procedure

Manish Mehta, Frank J. Veith, Takao Ohki, Jacob Cynamon, Kenneth Goldstein, William D. Suggs, Reese A. Wain, David W. Chang, Steven G. Friedman, Larry A. Scher, Evan C. Lipsitz

Research output: Contribution to journalArticle

213 Citations (Scopus)

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 (AlAs). Methods: From 1992 to 2000, 154 patients with abdominal aortic aneurysms (n = 66), iliac aneurysms (n = 28), or AlAs (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.

Original languageEnglish (US)
JournalJournal of Vascular Surgery
Volume33
Issue number2 SUPPL.
StatePublished - 2001

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Aneurysm
Arteries
Buttocks
Iliac Artery
Femoral Artery
Iliac Aneurysm
Ischemic Colitis
Morbidity
Transplants
Aortic Aneurysm
Abdominal Aortic Aneurysm
Erectile Dysfunction
Neurologic Manifestations
Laparotomy
Lower Extremity
Shock
Industry
Necrosis
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Unilateral and bilateral hypogastric artery interruption during aortoiliac aneurysm repair in 154 patients : A relatively innocuous procedure. / Mehta, Manish; Veith, Frank J.; Ohki, Takao; Cynamon, Jacob; Goldstein, Kenneth; Suggs, William D.; Wain, Reese A.; Chang, David W.; Friedman, Steven G.; Scher, Larry A.; Lipsitz, Evan C.

In: Journal of Vascular Surgery, Vol. 33, No. 2 SUPPL., 2001.

Research output: Contribution to journalArticle

Mehta, Manish ; Veith, Frank J. ; Ohki, Takao ; Cynamon, Jacob ; Goldstein, Kenneth ; Suggs, William D. ; Wain, Reese A. ; Chang, David W. ; Friedman, Steven G. ; Scher, Larry A. ; Lipsitz, Evan C. / Unilateral and bilateral hypogastric artery interruption during aortoiliac aneurysm repair in 154 patients : A relatively innocuous procedure. In: Journal of Vascular Surgery. 2001 ; Vol. 33, No. 2 SUPPL.
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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 (AlAs). Methods: From 1992 to 2000, 154 patients with abdominal aortic aneurysms (n = 66), iliac aneurysms (n = 28), or AlAs (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.",
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T1 - Unilateral and bilateral hypogastric artery interruption during aortoiliac aneurysm repair in 154 patients

T2 - A relatively innocuous procedure

AU - Mehta, Manish

AU - Veith, Frank J.

AU - Ohki, Takao

AU - Cynamon, Jacob

AU - Goldstein, Kenneth

AU - Suggs, William D.

AU - Wain, Reese A.

AU - Chang, David W.

AU - Friedman, Steven G.

AU - Scher, Larry A.

AU - Lipsitz, Evan C.

PY - 2001

Y1 - 2001

N2 - 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 (AlAs). Methods: From 1992 to 2000, 154 patients with abdominal aortic aneurysms (n = 66), iliac aneurysms (n = 28), or AlAs (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.

AB - 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 (AlAs). Methods: From 1992 to 2000, 154 patients with abdominal aortic aneurysms (n = 66), iliac aneurysms (n = 28), or AlAs (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.

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