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Preservation of pelvic circulation with hypogastric artery bypass in endovascular repair of abdominal aortic aneurysm with bilateral iliac artery aneurysms.
J Vasc Surg. 2006 Dec; 44(6):1170-5.JV

Abstract

PURPOSE

The endovascular repair (EVAR) of an abdominal aortic aneurysm (AAA) with a bilateral common iliac artery aneurysm (CIAA) often requires exclusion of the bilateral hypogastric artery (HA), which can be associated with pelvic ischemic complications such as erectile dysfunction and buttock claudication. This study assessed the effect of HA bypass on improving pelvic circulation.

METHODS

Five patients who underwent endovascular repair with HA bypass for an AAA with bilateral CIAA were evaluated. In all patients, the patency of the inferior mesenteric artery and bilateral HAs arteries was confirmed with preoperative computed tomography (CT) scans and angiography. During EVAR, penile blood flow was monitored with pulse-volume plethysmography measuring the penile brachial pressure index (PBI), and bilateral buttock blood flow was monitored with near-infrared spectroscopy measuring the gluteal tissue oxygenation index (TOI). An aortouni-external iliac artery stent graft with a crossover bypass was performed after embolization of the contralateral HA. HA bypass was performed between the crossover bypass graft and the ipsilateral HA via a retroperitoneal incision.

RESULTS

Unilateral coil embolization of the contralateral side HA trunk slightly decreased blood flow to the contralateral side buttock but did not cause significant changes in penile blood flow. At the completion of EVAR, the levels of both PBI and the contralateral side TOI were significantly lower than the baseline levels. After ipsilateral side HA revascularization with HA bypass, both PBI and bilateral gluteal flow returned almost to the baseline levels. Postoperative angiography and CT scans demonstrated the patency of all HA bypasses and no endoleaks. None of the patients experienced new onset of erectile dysfunction or buttock claudication 1 month after surgery.

CONCLUSION

Bilateral HA interruption during EVAR for AAA with bilateral CIAA was associated with significant depletion of both penile and gluteal blood flow. Intraoperative monitoring of PBI and TOI at the bilateral buttocks showed significant improvement of both parameters after HA bypass. HA bypass is an excellent procedure to improve pelvic circulation despite its increased surgical complexity.

Authors+Show Affiliations

Division of Vascular Surgery, Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan. unno@hama-med.ac.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

17145417

Citation

Unno, Naoki, et al. "Preservation of Pelvic Circulation With Hypogastric Artery Bypass in Endovascular Repair of Abdominal Aortic Aneurysm With Bilateral Iliac Artery Aneurysms." Journal of Vascular Surgery, vol. 44, no. 6, 2006, pp. 1170-5.
Unno N, Inuzuka K, Yamamoto N, et al. Preservation of pelvic circulation with hypogastric artery bypass in endovascular repair of abdominal aortic aneurysm with bilateral iliac artery aneurysms. J Vasc Surg. 2006;44(6):1170-5.
Unno, N., Inuzuka, K., Yamamoto, N., Sagara, D., Suzuki, M., & Konno, H. (2006). Preservation of pelvic circulation with hypogastric artery bypass in endovascular repair of abdominal aortic aneurysm with bilateral iliac artery aneurysms. Journal of Vascular Surgery, 44(6), 1170-5.
Unno N, et al. Preservation of Pelvic Circulation With Hypogastric Artery Bypass in Endovascular Repair of Abdominal Aortic Aneurysm With Bilateral Iliac Artery Aneurysms. J Vasc Surg. 2006;44(6):1170-5. PubMed PMID: 17145417.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preservation of pelvic circulation with hypogastric artery bypass in endovascular repair of abdominal aortic aneurysm with bilateral iliac artery aneurysms. AU - Unno,Naoki, AU - Inuzuka,Kazunori, AU - Yamamoto,Naoto, AU - Sagara,Daisuke, AU - Suzuki,Minoru, AU - Konno,Hiroyuki, PY - 2006/04/28/received PY - 2006/08/04/accepted PY - 2006/12/6/pubmed PY - 2007/1/20/medline PY - 2006/12/6/entrez SP - 1170 EP - 5 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 44 IS - 6 N2 - PURPOSE: The endovascular repair (EVAR) of an abdominal aortic aneurysm (AAA) with a bilateral common iliac artery aneurysm (CIAA) often requires exclusion of the bilateral hypogastric artery (HA), which can be associated with pelvic ischemic complications such as erectile dysfunction and buttock claudication. This study assessed the effect of HA bypass on improving pelvic circulation. METHODS: Five patients who underwent endovascular repair with HA bypass for an AAA with bilateral CIAA were evaluated. In all patients, the patency of the inferior mesenteric artery and bilateral HAs arteries was confirmed with preoperative computed tomography (CT) scans and angiography. During EVAR, penile blood flow was monitored with pulse-volume plethysmography measuring the penile brachial pressure index (PBI), and bilateral buttock blood flow was monitored with near-infrared spectroscopy measuring the gluteal tissue oxygenation index (TOI). An aortouni-external iliac artery stent graft with a crossover bypass was performed after embolization of the contralateral HA. HA bypass was performed between the crossover bypass graft and the ipsilateral HA via a retroperitoneal incision. RESULTS: Unilateral coil embolization of the contralateral side HA trunk slightly decreased blood flow to the contralateral side buttock but did not cause significant changes in penile blood flow. At the completion of EVAR, the levels of both PBI and the contralateral side TOI were significantly lower than the baseline levels. After ipsilateral side HA revascularization with HA bypass, both PBI and bilateral gluteal flow returned almost to the baseline levels. Postoperative angiography and CT scans demonstrated the patency of all HA bypasses and no endoleaks. None of the patients experienced new onset of erectile dysfunction or buttock claudication 1 month after surgery. CONCLUSION: Bilateral HA interruption during EVAR for AAA with bilateral CIAA was associated with significant depletion of both penile and gluteal blood flow. Intraoperative monitoring of PBI and TOI at the bilateral buttocks showed significant improvement of both parameters after HA bypass. HA bypass is an excellent procedure to improve pelvic circulation despite its increased surgical complexity. SN - 0741-5214 UR - https://www.unboundmedicine.com/medline/citation/17145417/Preservation_of_pelvic_circulation_with_hypogastric_artery_bypass_in_endovascular_repair_of_abdominal_aortic_aneurysm_with_bilateral_iliac_artery_aneurysms_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(06)01390-5 DB - PRIME DP - Unbound Medicine ER -