Open Surgical Management of Hypogastric Artery during Aortic Surgery: Ligate or Not Ligate?

Michele Marconi; Sabrina Ceragioli; Davide M Mocellin; Aldo Alberti; Francesca Tomei; Daniele Adami; Raffaella N Berchiolli; Mauro Ferrari

doi:10.1016/j.avsg.2014.12.025

Open Surgical Management of Hypogastric Artery during Aortic Surgery: Ligate or Not Ligate?

Ann Vasc Surg. 2015;29(4):780-5. doi: 10.1016/j.avsg.2014.12.025. Epub 2015 Feb 27.

Authors

Michele Marconi¹, Sabrina Ceragioli², Davide M Mocellin², Aldo Alberti², Francesca Tomei², Daniele Adami², Raffaella N Berchiolli², Mauro Ferrari²

Affiliations

¹ Vascular Surgery Unit, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy. Electronic address: michemarconi@gmail.com.
² Vascular Surgery Unit, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy.

PMID: 25733215
DOI: 10.1016/j.avsg.2014.12.025

Abstract

Background: Abdominal aortic aneurysm (AAA) is associated with 43% of cases with common iliac artery aneurysms and an extension of prosthetic replacement distal to the iliac bifurcation is needed. The decision about preserving the hypogastric artery (HA) is a source of discussion, in particular when only one HA is interested. The low risk of pelvic ischemia, even if existing, has to be compared with the greater technical difficulty of the vascular reconstruction. The aim of this study is to evaluate retrospectively the perioperative results in patients who underwent ligation or reconstruction of the HA during open surgical procedures for AAA.

Methods: Over a period of 11 years (January 2002 to December 2012), 1,487 patients were treated electively for AAA. In 235 cases (15.8%), the aneurysm involved the iliac bifurcation with need to extend distally the prosthetic reconstruction; among them, 63 patients were subjected to HA ligation (26.8%, group 1) and 172 to HA bypass (73.2%, group 2). Indication for ligation was the presence of extended HA aneurysm in 34 cases (54%) and heavy calcification of HA in 29 (46%).

Results: Perioperative mortality and morbidity rates were, respectively, 1.6% (1/63) and 7.9% (5/63) in group 1 and 1.2% (2/172) and 6.4% (11/172) in group 2 (P = 0.902 and 0.689). The incidence of buttock claudication was significantly higher in group 1 (6/63, 9.5% vs. 4/172, 2.3% P = 0.025), while there were no significant differences in other complications of pelvic ischemia. In group 2, higher intraoperative blood loss (754 ± 721 vs. 996 ± 608 mL, P = 0.011), longer operating time (283.2 ± 104.7 vs. 302 ± 109 min, P = 0.053), and longer postoperative length of stay (PLOS) (5.8 ± 2.2 vs. 6.7 ± 3.6 days, P = 0.049) occurred.

Conclusions: HA bypass during open surgery for AAA is a safe procedure. If compared with ligation, it reduces the risk of buttock claudication without increasing perioperative morbidity and mortality. However, the increased complexity of the intervention involves an increase in blood loss, operating time, and PLOS.

MeSH terms

Aged
Aortic Aneurysm, Abdominal / diagnosis
Aortic Aneurysm, Abdominal / mortality
Aortic Aneurysm, Abdominal / physiopathology
Aortic Aneurysm, Abdominal / surgery*
Arteries / physiopathology
Arteries / surgery*
Blood Loss, Surgical
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation* / adverse effects
Blood Vessel Prosthesis Implantation* / instrumentation
Blood Vessel Prosthesis Implantation* / methods
Blood Vessel Prosthesis Implantation* / mortality
Female
Humans
Iliac Aneurysm / diagnosis
Iliac Aneurysm / mortality
Iliac Aneurysm / physiopathology
Iliac Aneurysm / surgery*
Ischemia / etiology
Ischemia / physiopathology
Length of Stay
Ligation
Male
Operative Time
Pelvis / blood supply*
Prosthesis Design
Regional Blood Flow
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome