In Patients Who Require Hypogastric Artery Coverage to Treat an AAA with EVAR, Does Preservation Improve Outcomes When Compared to Exclusion of the Vessel?

Abstract

Hypogastric artery exclusion has been utilized as a means to extend applicability of endovascular aortic repair to patients with complex aortoiliac aneurysmal disease. Since its introduction, the technique has been associated with ischemic complications, notably buttock claudication and erectile dysfunction, which can affect quality of life. Both the incidence of buttock claudication and its duration are varied in the literature. Serious complications (gluteal necrosis, colon ischemia, and paraplegia), however, are exceedingly rare even with bilateral hypogastric occlusion. Several patient and technical factors have been studied that may predict those at higher risk of developing ischemic complications, as these patients stand to benefit the most from hypogastric preservation. A variety of open and endovascular techniques are available to preserve hypogastric circulation during aneurysm repair, each with its own limitations. Data regarding the use of these adjunctive techniques comes primarily from small studies with short term follow-up. Further research into the long term efficacy of these techniques is warranted.