Hypogastric artery embolization in endovascular abdominal aortic aneurysm repair

Purpose: Iliac artery anatomy is a central factor in endoluminal abdominal aortic aneurysm therapy. It serves as the conduit for graft deployment and as the region of distal graft seal. Thirty-eight percent of iliac vessels i n our patients require special treatment because of aneurysms, tortuosity, or small size. Bilateral hypogastric artery exclusion has been avoided beca use of concerns of colorectal ischemia, hip/buttock claudication, and impot ence. We suggest that elective, staged, bilateral hypogastric embolization can be performed safely with reasonably low morbidity and can expand the an atomic boundaries for stent-graft abdominal aortic aneurysm repair. Methods: This study was performed as a retrospective chart review of patien ts requiring hypogastric artery embolization for endovascular repair of abd ominal aortic aneurysms between Tune 1998 and Tune 2000. Patients with othe rwise appropriate anatomy and common iliac artery aneurysms were informed o f the option for stent-graft repair with internal iliac artery embolization with its risks Of impotence, hip/buttock claudication, and bon el ischemia . Patients underwent unilateral or staged bilateral coil embolizations of t heir proximal hypogastric arteries with an approximate 1-week interval betw een procedures. Hospital and office records were reviewed; phone interviews were performed. Follow-up ranged from 1 to 12 months. Results: During a 24-month period, 65 patients underwent endovascular abdom inal aortic aneurysm repair; 18 patients (28%) required hypogastric artery embolization. Seven (39%) of these patients underwent bilateral embolizatio n. There were no episodes of clinically evident bowel ischemia. Lactate lev els were normal in all measured patients. Postoperative fevers (> 101.0 deg reesF) were documented in 10 (56%) of 18 patients. The average white blood cell count was 12.8 x 10(9)/L (range, 8.5-22.9). There were no positive blo od culture results. The return to the full preoperative diet occurred in 1 to 3 days. Hip/buttock claudication occurred in approximately 50% of patien ts with persistent but improved symptoms at 6 months. Eighty-seven percent of patients had preoperative erectile dysfunction. Only two patients noted worsening of erectile function postoperatively. Conclusions: Preliminary results indicate that bilateral hypogastric artery embolization can be performed, when necessary, with reasonable morbidity i n patients undergoing stent-graft abdominal aortic aneurysm repair.