Hypogastric artery preservation during endovascular aortic aneurysm repair: is it important?

Endovascular repair of aortoiliac artery aneurysm is a safe and effective treatment strategy. Selective hypogastric artery embolization with coils may be necessary to allow the endograft to anchor in the aneurysm-free external iliac artery, thereby eliminating hypogastric endoleak into the aortoiliac aneurysm. Considerable controversy exists regarding the safety of intentional occlusion of the hypogastric artery. Proximal occlusion of a hypogastric artery with embolic coils typically produces little or no clinical symptoms due to well-collateralized pelvic arterial networks. On the other hand, significant complications, such as colonic ischemia, spinal cord paralysis, buttock claudication, or erectile dysfunction are well-recognized adverse events after hypogastric artery embolization. This article examines the natural history of hypogastric artery embolization as well as clinical data regarding the safety and complications following this procedure. Clinical studies regarding risk factors that might contribute to ischemic complication following hypogastric artery embolization are presented. Lastly, treatment strategies to preserve the hypogastric artery thereby obviating the need for hypogastric artery embolization are discussed.