Pelvic revascularization by direct hypogastric artery reconstruction

While pelvic arterial insufficiency, either acute or chronic, results in stereotypic clinical findings which may readily be reversed by indirect techniques of revascularization, few reports document the indications for, techniques of, and results following direct pelvic revascularization by reconstruction of the hypogastric artery.

Retrospective review of 8 patients with symptomatic pelvic arterial insufficiency undergoing direct hypogastric artery reconstruction during the period from 1984 to 1995.

Eight patients underwent unilateral hypogastric artery reconstruction by bypass graft (3 patients) or endarterectomy and patch angioplasty (5 patients). One patient had immediate symptomatic relief of his symptoms, but was lost to follow-up after 1 month. One patient manifested no symptomatic improvement despite a technically successful operation. The remaining 6 patients experienced significant symptomatic relief that has persisted during follow-up from 3 months to 11 years postoperatively. Among 4 men in whom erectile impotence comprised one of the indications for intervention, 3 reported sustained restoration of sexual function.

In properly selected patients, direct pelvic revascularization by hypogastric artery reconstruction may predictably and durably relieve symptoms of pelvic arterial insufficiency.