TY - JOUR
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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U2 - 10.1067/mva.2001.111678
DO - 10.1067/mva.2001.111678
M3 - Article
C2 - 11174809
AN - SCOPUS:17144467266
SN - 0741-5214
VL - 33
SP - 27
EP - 32
JO - Journal of Vascular Surgery
JF - Journal of Vascular Surgery
IS - 2 SUPPL.
ER -