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Outcome after unilateral hypogastric artery occlusion during endovascular aneurysm repair
W A Lee1, J O'Dorisio, Y G Wolf
1Division of Vascular Surgery, Stanford University, CA, USA.
Insights
Unilateral hypogastric artery occlusion during endovascular aneurysm repair can cause symptoms in 39% of patients. While most improve, functional outcomes do not fully recover, yet patients still prefer endovascular repair.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Aortoiliac Aneurysm Repair
Background:
- Endovascular stent graft repair is a common treatment for aortoiliac aneurysms.
- Unilateral hypogastric artery occlusion is a potential complication of this procedure.
Purpose of the Study:
- To evaluate the long-term functional outcomes after unilateral hypogastric artery occlusion.
- To assess the impact of inadvertent hypogastric artery occlusion on patient activity levels and symptoms.
Main Methods:
- A cohort of 157 patients undergoing endovascular repair was analyzed.
- 23 patients with unilateral hypogastric artery occlusion were identified via CT scans.
- Functional outcomes were assessed using telephone interviews and a disability score (DS).
Main Results:
- 39% of patients reported symptoms of hip and buttock claudication ipsilateral to the occlusion.
- The mean disability score decreased by 3.3 postoperatively in symptomatic patients.
- 89% of symptomatic patients experienced improvement, but none returned to baseline activity levels.
Conclusions:
- Hypogastric artery occlusion can lead to significant, albeit often improving, functional deficits.
- Despite potential symptoms, patients overwhelmingly prefer endovascular repair over open surgery.
Purpose:
The purpose of this study was to determine the long-term functional outcome after unilateral hypogastric artery occlusion during endovascular stent graft repair of aortoiliac aneurysms.
Methods:
During a 41-month period, 157 consecutive patients underwent elective endovascular stent graft repair of aortoiliac aneurysms with the Medtronic AneuRx device. Postoperative computed tomography scans were compared with preoperative scans to identify new hypogastric artery occlusions. Twenty-three (15%) patients had unilateral hypogastric occlusion, and there were no cases of bilateral occlusions. Telephone interviews about past and current levels of activity and symptoms were conducted, and pertinent medical records were reviewed. All 23 (100%) patients were available for the telephone interview. A disability score (DS) was quantitatively graded on a discrete scale ranging from 0 to 10 corresponding to "virtually bed-bound" to "greater-than-a-mile" exercise tolerance. Worsening or improvement of symptoms was expressed as a difference in DS between two time points (-, worsening/+, improving).
Results:
Among the 23 patients, two groups were identified: 10 patients (43%) had planned and 13 patients (57%) had unplanned or inadvertent occlusions. The patients in the two groups did not differ significantly in the mean age (73.4 vs 73.7 years), sex (male:female, 9:1 vs 10:3), and duration of follow-up (15.6 vs 14.4 months). Nine (39%) of the 23 patients, five patients in the planned and four patients in the unplanned group, reported significant symptoms of hip and buttock claudication ipsilateral to their occluded hypogastric arteries. The mean decrement from baseline of these nine patients in their DS postoperatively was -3.3. The symptoms were universally noted on postoperative day 1. Although most patients improved (89%), one (11%) never got better. Among those whose symptoms improved, the mean time to improvement was 15 weeks, but with a plateau thereafter resulting in a net decrement of DS of -2.3 from baseline. Finally, when questioned whether they would undergo the procedure again, all 23 patients unanimously answered, "Yes."
Conclusions:
A significant number (39%) of patients who sustain hypogastric artery occlusion after endovascular aneurysm repair have symptoms. Although most patients with symptoms have some improvement, none return to their baseline level of activity. Despite this, all patients in retrospect would again choose endovascular repair over conventional open repair.