Clinical and Functional Impact of Hypogastric Artery Exclusion During EVAR

Wassim Mansour; Laura Capoccia; Pasqualino Sirignano; Nunzio Montelione; Chiara Pranteda; Martina Formiconi; Enrico Sbarigia; Francesco Speziale

doi:10.1177/1538574416665968

Clinical and Functional Impact of Hypogastric Artery Exclusion During EVAR

Vasc Endovascular Surg. 2016 Oct;50(7):484-490. doi: 10.1177/1538574416665968. Epub 2016 Sep 20.

Authors

Wassim Mansour¹, Laura Capoccia², Pasqualino Sirignano², Nunzio Montelione², Chiara Pranteda², Martina Formiconi², Enrico Sbarigia², Francesco Speziale²

Affiliations

¹ Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy mansour.wassim@gmail.com.
² Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.

PMID: 27651428
DOI: 10.1177/1538574416665968

Abstract

Purpose: Hypogastric artery (HA) revascularization during endovascular aneurysm repair (EVAR) is still open to debate. Moreover, exclusion-related complication rates reported in literature are not negligible. The aim of this study is to present and analyze the outcomes in patients undergoing EVAR with exclusion of 1 or both HAs at our academic center.

Methods: We retrospectively reviewed our results in patients submitted to EVAR and needing HA exclusion, in terms of perioperative (30-day) and follow-up rates of intestinal and spinal cord ischemia, buttock claudication, buttock skin necrosis, and sexual dysfunction.

Results: From January 2008 to December 2014, a total of 527 patients underwent elective standard infrarenal EVAR; among those 104 (19.7%) had iliac involvement needing HA exclusion. In 73 patients with unilateral iliac involvement (70.1%, group UH), many single HAs were excluded. Thirty-one patients (29.9%) had bilateral iliac involvement (group BH), of which 16 (51.6%) had 1 HA excluded with revascularization of the contralateral one (group BHR); in the remaining 15 patients (48.4%) both HAs were excluded (group BHE). No 30-day or follow-up aneurysm-related mortality, intestinal, or spinal cord ischemia were recorded. At 30 days, skin necrosis was observed in 2 patients. Buttock claudication and sexual dysfunction rates were significantly greater in group BHE than in group BHR (P < .05). At a mean 18.6 months follow-up (range: 4-47), buttock claudication and sexual dysfunction rates in group BHE were persistently higher than that in groups UH and BHR (P < .05); HA coil embolization was significantly associated with buttock claudication and sexual dysfunction (P < .05).

Conclusions: Whenever anatomically feasible, at least 1 HA should be salvaged in case of bilateral involvement. In case of unilateral HA exclusion, the rate of complications is not negligible. Coil embolization is related to a higher complication rate.

Keywords: buttock claudication; endovascular revascularization; hypogastric artery; sexual dysfunction.

MeSH terms

Academic Medical Centers
Aged
Aortic Aneurysm, Abdominal / diagnostic imaging
Aortic Aneurysm, Abdominal / surgery*
Aortography / methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation* / adverse effects
Blood Vessel Prosthesis Implantation* / instrumentation
Computed Tomography Angiography
Databases, Factual
Embolization, Therapeutic / adverse effects*
Embolization, Therapeutic / instrumentation
Endovascular Procedures* / adverse effects
Endovascular Procedures* / instrumentation
Female
Humans
Italy
Male
Pelvis / blood supply*
Postoperative Complications / etiology
Prosthesis Design
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome