Endovascular Treatment for Symptomatic Hypogastric Artery Stenosis or Occlusion: A Systematic Review and
Nicola Cicala1, Claudio Bianchini Massoni2, Davide Maria Pressanto1
1Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy.
Background:
This systematic review and meta-analysis aimed to evaluate indications, techniques, and outcomes of endovascular treatment for symptomatic hypogastric artery lesions.
Data Source:
A systematic literature search (PubMed, Web of Science, Scopus, and Cochrane Library) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed (PROSPERO registration number CRD420251232230).
Methods:
Studies including at least 5 cases of symptomatic hypogastric artery lesions, treated with endovascular technique, were included. Primary outcomes were technical success (TS) and clinical success (CS). Secondary end points included patency, reintervention, and complications. Meta-analyses of proportions were performed using a random-effects model.
Results:
Six studies comprising 95 patients and 117 treated hypogastric arteries were included. Mean age was 67.46 years (95% confidence interval [CI] 65.3-69.6; P = 0.018), and 89.9% of patients (95% CI 83.9-95.8; P = 0.775) were male. The hypogastric lesions were predominantly unilateral 72.5% (95% CI 53-91.9; P < 0.001) and stenosis 89.5% (95% CI 80.9-98.2; P = 0.013). Percutaneous transluminal angioplasty was used in 54.1% (95% CI 16.6-91.5; P < 0.01) of cases and stent placement in 45.9% (95% CI 8.5-83.4; P < 0.1) of cases. TS was 96.1% (95% CI 92.6-99.5; P = 0.860). Postoperative CS was achieved in 90.4% (95% CI 82.8-98.1; P = 0.114) of cases, with complete symptom resolution in 83.9% (95% CI 70.1-97.8; P < 0.001) of cases. Mean follow-up was 12.57 months (95% CI 4.39-20.7; P < 0.001). Estimated primary patency rate was 93.4% (95% CI 87.5-99.3; P = 0.081). Reintervention was required in 4.3% (95% CI 0.8-7.9; P = 0.477) of patients. No perioperative or follow-up mortality was reported.
Conclusion:
Endovascular treatment of symptomatic hypogastric steno-occlusive lesions is safe, technically feasible, and associated with high CS and excellent mid-term patency, with minimal morbidity and no reported postoperative mortality.
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