Hypogastric Artery Management During Open and Endovascular Aortoiliac Repair

Purpose: To report a case of chronic intermittent spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) and its successful treatment using hypogastric artery stenting. Case Report: A 79-year-old patient presented in May 2013 with a thoracic aortic aneurysm (TAA) and a contained rupture. He urgently underwent TEVAR that covered 274 mm of descending thoracic aorta without immediate postoperative signs of acute SCI. At 3-month follow-up, he reported repeating incidents of sudden lower extremity weakness leading to a fall with a humerus fracture. A neurological consultation revealed the tentative diagnosis of intermittent SCI caused by TEVAR and initially recommended a conservative approach. During the following year there was no clinical improvement of the symptoms. Computed tomography angiography showed a high-grade stenosis of the right hypogastric artery, which was stented in November 2014 to improve the collateral network of spinal cord perfusion. Following treatment, the patient had no further neurological symptoms; at 32 months after the reintervention, the imaging follow-up documented a patent stent and continued exclusion of the TAA. Conclusion: Intermittent neurological symptoms after TEVAR should be suspected as chronic intermittent SCI. The improvement of collateral networks of the spinal cord by revascularization of the hypogastric artery is a viable treatment option.

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Surgical and Endovascular Management of Isolated Internal Iliac Artery Aneurysms: A Systematic Review and Meta-Analysis

Vascular and Endovascular Surgery ◽

10.1177/1538574420981812 ◽

2020 ◽

pp. 153857442098181

Author(s):

Paolo Perini ◽

Erica Mariani ◽

Mara Fanelli ◽

Alessandro Ucci ◽

Giulia Rossi ◽

...

Keyword(s):

Systematic Review ◽

Iliac Artery ◽

Endovascular Repair ◽

Open Surgery ◽

Internal Iliac Artery ◽

Cochrane Library ◽

Hypogastric Artery ◽

Stent Grafting ◽

Buttock Claudication ◽

Internal Iliac

Objectives: The purpose of this paper is to report the different modalities for the treatment of isolated internal iliac artery aneurysms (IIIAA), as well as their outcomes. Methods: We performed a systematic review of the literature (database searched: PubMed, Web of Science, Scopus, Cochrane Library; last search: April 2020). We included articles reporting on the outcomes for IIIAA interventions comprising at least 5 patients. Studies were included when presenting extractable outcome data regarding intraoperative and/or early results. We performed meta-analyses of proportions for different outcomes, using random effects model. Results: Thirteen non-randomized studies were included (192 patients with 202 IIIAA). IIIAA were symptomatic in the 18.1% (95%CI 9.3-26.9; I2 54.46%, P = .019). Estimated mean IIIAA diameter was 46.28 mm (95%CI 39.72-52.85; I2 88.85%, P < .001). Open repair was performed in 21/202 cases. Endovascular treatments were: embolization (81/181), embolization and hypogastric artery coverage (79/181), hypogastric artery coverage by stent-grafting (15/181), stent-grafting in the hypogastric artery (6/181). Overall estimated technical success (TS) rate was 91.6% (95% CI 86.8-95.5; I2 45.82%, P = .031). TS rate was 94.5% for open surgery (95%CI 85.3-100; I2 0%, P = .907), and 89.7% for endovascular repair (95%CI 83.8-95.6; I2 55.43%, P = .006). Estimated overall 30-day mortality was 3.1% (95%CI 0.8-5.4; I2 0%, P = .969). Mortality rates after open surgery and endovascular repair were 8.2% (95%CI 3.4-19.8; I2 0%, P = .545) and 2.8% (95%CI 0.5-5.1; I2 0%, P = .994), respectively. Estimated mean follow-up was 32.63 months (95%CI 21.74-43.53; I2 94.45%, P < .001). During this timeframe, IIIAA exclusion was preserved in 92.8% of the patients (95%CI 89.3-96.2; I2 0%, P = .797). Buttock claudication occurred in 13.9% of the patients (95%CI 8.7-19.2; I2 0%, P = .622). Conclusions: IIIAA are frequently large, and symptomatic at presentation. Several treatments are proposed in literature, open and endovascular, both with good results. The endovascular treatment is the preferred method of treatment in literature, since it offers good short- to mid-term results and low early mortality. Buttock claudication after hypogastric artery exclusion is a common complication.

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Hypogastric Artery-Colonic Fistula After Coil Embolization of Left Hypogastric Artery Aneurysm

Annals of Vascular Surgery ◽

10.1016/j.avsg.2020.12.010 ◽

2021 ◽

Author(s):

Atbin Doroodchi ◽

Mrinal Shukla ◽

Manuel Ramirez ◽

Gautam Agarwal

Keyword(s):

Coil Embolization ◽

Artery Aneurysm ◽

Hypogastric Artery ◽

Colonic Fistula ◽

Hypogastric Artery Aneurysm

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Prophylactic Hypogastric Artery Ligation during Placenta Percreta Surgery: A Retrospective Cohort Study

American Journal of Perinatology Reports ◽

10.1055/s-0038-1666793 ◽

2018 ◽

Vol 08 (02) ◽

pp. e142-e145

Author(s):

Theresa Kuhn ◽

Kristina Martimucci ◽

Abdulla Al-Khan ◽

Robyn Bilinski ◽

Stacy Zamudio ◽

...

Keyword(s):

Blood Loss ◽

Retrospective Cohort ◽

Placenta Percreta ◽

Control Group ◽

Study Group ◽

Distributed Data ◽

Hypogastric Artery ◽

Blood Products ◽

Artery Ligation ◽

Cesarean Hysterectomy

Objective To evaluate if prophylactic hypogastric artery ligation (HAL) decreases surgical blood loss and blood products transfused. Study Design This is a retrospective cohort study comparing patients with placenta percreta undergoing prophylactic HAL at the time of cesarean hysterectomy versus those who did not. Data were presented as means ± standard deviations, proportions, or medians with interquartile ranges. Demographic and clinical data were compared in the groups using Student's t-test for normally distributed data or the Mann–Whitney U test for nonnormally distributed data. Fisher's exact test was used for proportions and categorical variables. Data are reported as significant where p was <0.05. Results There were 26 patients included in the control group with no HAL and 11 patients included in the study group. Estimated blood loss for the study group was 1,000 mL versus 800 mL in the control. Units of PRCBs transfused were 4.5 units in the study group versus 2 units for the control group. None of these measures were found to be statistically significant. Conclusion Our data suggest there was no benefit in the use of prophylactic HAL in decreasing surgical blood loss or amount of blood products transfused in patients who had a cesarean hysterectomy performed for placenta percreta. Précis Prophylactic HAL does not decrease blood loss during surgery for placenta percreta.

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Surgical treatment of post-partum haemorrhage: how to improve the results of hypogastric artery ligation

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2016.07.146 ◽

2016 ◽

Vol 206 ◽

pp. e48

Author(s):

A. Halouani ◽

M. Kehila ◽

S. Derouich ◽

O. Touhami ◽

M. Chemkhi ◽

...

Keyword(s):

Surgical Treatment ◽

Post Partum ◽

Hypogastric Artery ◽

Artery Ligation ◽

Post Partum Haemorrhage

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Successful Sac Embolization to Eliminate a Type 2 Endoleak After Thoracic Endovascular Aortic Repair by Penetration of a Vascular Plug Implanted in a Left Subclavian Artery

Journal of Endovascular Therapy ◽

10.1177/15266028211067730 ◽

2021 ◽

pp. 152660282110677

Author(s):

Satoru Nagatomi ◽

Shigeo Ichihashi ◽

Daigo Kanamori ◽

Hiroshi Yamamoto

Keyword(s):

Aortic Aneurysm ◽

Subclavian Artery ◽

Left Subclavian Artery ◽

Side Branch ◽

Hypogastric Artery ◽

Vascular Plug ◽

Type 2 Endoleak ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Purpose: To describe a technique of vascular plug penetration by a guidewire with a heavy tip load for additional embolization of a type 2 endoleak after endovascular aortic aneurysm repair (EVAR). Technique: The technique of vascular plug penetration is effective for additional embolization of a type 2 endoleak, when large arteries such as left subclavian artery (LSA) or hypogastric artery remain patent even after the embolization of the vessel has been performed using a vascular plug and are responsible for the endoleak. A tapered guidewire with a heavy tip load enables the penetration of the disk of the plug, followed by introduction of a microcatheter into the endoleak nidus. In the presented case, the technique successfully eliminated a type 2 endoleak in a thoracic aortic aneurysm for which a patent LSA despite the embolization by a vascular plug was responsible. Conclusion: The technique of vascular plug penetration allows an access to an endoleak cavity via a vascular plug placed in an aortic side branch for additional embolization of a type 2 endoleak after EVAR.

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