Unilateral and bilateral hypogastric artery interruption during aortoiliacaneurysm repair in 154 patients: A relatively innocuous procedure

Objective: Hypogastric artery (HA) occlusion during aortic aneurysm repair has been associated with considerable morbidity. We analyzed the consequenc es of interrupting one or both HAs in the standard surgical or endovascular treatment of aortoiliac aneurysms (AIAs). Methods: From 1992 to 2000, 154 patients with abdominal aortic aneurysms (n = 66), iliac aneurysms (n = 28), or AIAs (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 varie ty of industry- or surgeon-made grafts in combination with coil embolizatio n of the HAs. The standard surgical techniques included oversewing or exclu ding the origins of the HAs and extending the prosthetic graft to the exter nal iliac or femoral artery. Results: There were no cases of buttock necrosis, ischemic colitis requirin g laparotomy, or death when one or both HAs were interrupted. Persistent bu ttock claudication occurred after 16 (12%) of the unilateral and 2 (11%) of the bilateral HA interruptions. Impotence occurred in 7 (9%) of the unilat eral and 2 (13%) of the bilateral HA interruptions. Minor neurologic defici ts of the lower extremity were observed in 2 (1.5%) of the patients with un ilateral HA interruption. Conclusions: Although HA flow should be preserved if possible, selective in terruption of one or both HAs can usually be accomplished safely during end ovascular and open repair of anatomically challenging AIAs. We believe othe r comorbid factors such as shock, distal embolization, or the failure to pr eserve collateral branches from the external iliac and femoral arteries may have contributed to the morbidity in other reports of HA interruption.