Hypogastric Artery Preservation during Endovascular Aortic Aneurysm Repair: Is It Important?

Endovascular repair of aortoiliac artery aneurysm is a safe and effective treatment strategy. Selective hypogastric artery embolization with coils may be necessary to allow the endograft to anchor in the aneurysm-free external iliac artery, thereby eliminating hypogastric endoleak into the aortoilia...

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Bibliographic Details
Published in:Seminars in vascular surgery 2009-09, Vol.22 (3), p.193-200
Main Authors: Lin, Peter H., MD, Chen, Aaron Y, Vij, Alok, BS
Format: Article
Language:English
Subjects:
Aortic Aneurysm - diagnostic imaging
Aortic Aneurysm - physiopathology
Aortic Aneurysm - surgery
Aortography
Blood Vessel Prosthesis Implantation - adverse effects
Blood Vessel Prosthesis Implantation - instrumentation
Blood Vessel Prosthesis Implantation - methods
Collateral Circulation
Embolization, Therapeutic - adverse effects
Female
Humans
Iliac Aneurysm - diagnostic imaging
Iliac Aneurysm - physiopathology
Iliac Aneurysm - surgery
Impotence, Vasculogenic - etiology
Ischemia - etiology
Male
Paralysis - etiology
Pelvis - blood supply
Regional Blood Flow
Risk Assessment
Risk Factors
Surgery
Treatment Outcome
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Summary:Endovascular repair of aortoiliac artery aneurysm is a safe and effective treatment strategy. Selective hypogastric artery embolization with coils may be necessary to allow the endograft to anchor in the aneurysm-free external iliac artery, thereby eliminating hypogastric endoleak into the aortoiliac aneurysm. Considerable controversy exists regarding the safety of intentional occlusion of the hypogastric artery. Proximal occlusion of a hypogastric artery with embolic coils typically produces little or no clinical symptoms due to well-collateralized pelvic arterial networks. On the other hand, significant complications, such as colonic ischemia, spinal cord paralysis, buttock claudication, or erectile dysfunction are well-recognized adverse events after hypogastric artery embolization. This article examines the natural history of hypogastric artery embolization as well as clinical data regarding the safety and complications following this procedure. Clinical studies regarding risk factors that might contribute to ischemic complication following hypogastric artery embolization are presented. Lastly, treatment strategies to preserve the hypogastric artery thereby obviating the need for hypogastric artery embolization are discussed.
ISSN:0895-7967
1558-4518
DOI:10.1053/j.semvascsurg.2009.07.012