Hypogastric Artery Bypass in Open Repair of Abdominal Aortoiliac Aneurysm: A Safe Procedure

Objectives: The aim of this study is to assess the immediate and mid-term results of hypogastric artery bypass (HAB) in open repair of abdominal aortic aneurysm (AAA). Methods: The clinical data of 24 patients with an average age of 70.4 years [standard deviation (S.D.)+/- 8.1 years] with AAA treated between January 2005 and December 2008 with HAB during open repair of aortoiliac aneurysm were reviewed. Eighteen patients received unilateral and six bilateral hypogastric bypasses, using a segment of Dacron graft prosthesis. Concomitant hypogastric eversion endarterectomy was associated in six cases (25%). Follow-up was complete in all the 24 patients and averaged 16.2 months (range 1-35). Postoperative imaging protocol involved a conventional Echocolordoppler and CT-scan. With respect to the operating time, the blood loss, the intensive care unit (ICU) and the length of ward admission (LWA) stay, we compared the 24 patients who underwent hypogastric bypass (group A) with the 50 patients who had bifurcated graft without hypogastric bypass (group B). Results: Between the two groups, statistically different results were demonstrated only with respect to the duration of operation (h) (group A 5.19 +/- 1.38 vs. group B 4.39 +/- 1.32, P=0.0195). No statistical differences were noted for ICU stay (h) (group A median 21.50 vs. group B median 21.3, range 1 degrees-3 degrees quartile 19.75-23.50) and LWA stay (days) (group A median 8.50, range 1 degrees-3 degrees quartile 7.00-11.50 vs. group B median 8.0, range 1 degrees-3 degrees quartile 7.00-9.00). There were no operative deaths, bowel or intestinal ischemia in the early postoperative period between the two groups. In group A, one patient had transient renal failure and one patient had an acute coronary syndrome. In group B, one patient had a peripheral ischemia who required tibioperoneal embolectomy. The patency of the hypogastric grafts was demonstrated in all cases. Conclusions: In our experience, direct revascularization of the hypogastric artery to ensure pelvic vascularization in aortoiliac surgery appears a safe procedure. (C) 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.