Material and method: The topography of the hypogastric (internal iliac) artery, its pelvic collateral anastomoses, the procedure and physiological consequences of hypogastric artery ligation are described. Indications and clinical findings in 117 cases of bilateral hypogastric artery ligation for uncontrollable pelvic bleeding are presented.
Results: In all 37 obstetric cases, hemorrhage was effectively controlled. There was no need for reoperation, and in 13 cases even the uterus could be preserved, with 4 women having delivered mature infants up until now. The uterus was successfully preserved even in cases such as cervical pregnancy, placenta previa, placental abruption, uterine atony, and uterine rupture. Out of 80 gynecological cases, hypogastric ligation was performed to control intractable hemorrhage in 41 patients, while prophylactic reduction of pelvic blood flow was the indication of the procedure in 39 cases. Prophylactic ligation was performed in 34 women because profuse bleeding was expected. In the remaining 5 cases, the procedure was done for requests of patients who were members of Jehova's Witnesses. Out of cases with preserved uterus one woman delivered mature infant up until now. Apart from a slight lesion of the hypogastric vein, no complications have been observed in relation to these 117 cases of bilateral hypogastric artery ligation.
Conclusion: It is emphasized that hypogastric artery ligation is indicated if (1) life-threatening pelvic hemorrhage cannot be controlled by conservative methods, (2) prophylactic reduction of pelvic blood flow is needed, (3) during the management of uncontrollable massive hemorrhage, preservation of reproductive functions and/or female identity is desirable. Ligation of the hypogastric artery has proven to be a safe and usually effective method. This easy-to-acquire technique should be practiced by most gynecologists and should be an integral part of obstetric and gynecological training.