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Hypogastric Preservation Using Retrograde Endovascular Bypass.

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Retrograde endovascular external iliac artery (EIA) to internal iliac artery (IIA) bypass is a safe and effective technique for preserving pelvic circulation. This method offers a low-risk, high-patency solution for patients with aortoiliac aneurysmal disease.

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Area of Science:

  • Vascular Surgery
  • Endovascular Techniques
  • Aortoiliac Aneurysm Repair

Background:

  • Pelvic circulation maintenance is crucial for preventing ischemic complications like colitis, claudication, and erectile dysfunction in extensive aortoiliac aneurysmal disease.
  • This study evaluates the long-term outcomes of endovascular external iliac artery (EIA) to internal iliac artery (IIA) bypass for pelvic circulation preservation.

Purpose of the Study:

  • To assess the mid-to-late follow-up results of patients treated with endovascular EIA-IIA bypass.
  • To determine the safety and efficacy of this technique in preserving pelvic circulation.

Main Methods:

  • Retrospective review of 17 patients undergoing elective retrograde EIA-IIA endovascular bypass from 2006-2016.
  • Inclusion criteria: common iliac artery aneurysms with bifurcation angle >45°, limiting distal landing zones.
  • Procedures involved aortouni-iliac endografts, cross-femoral bypass, and retrograde stent graft placement into the contralateral IIA.

Main Results:

  • 100% technical success rate with a mean operative time of 168 minutes and 71 cc contrast usage.
  • Over a mean follow-up of 29.8 months, no aorta-related mortalities, zero incidence of bowel ischemia, paralysis, or bowel/bladder dysfunction.
  • One asymptomatic EIA-IIA bypass occlusion and one reintervention for type II endoleak were noted; no additional endoleaks or sac growth occurred.

Conclusions:

  • Retrograde endovascular EIA-IIA bypass is a low-risk, high-patency option for preserving hypogastric artery flow.
  • This technique effectively maintains pelvic circulation in patients with complex aortoiliac disease.