HYPOGASTRIC ARTERY PRESERVATION DURING EVAR: SURGICAL AND ENDOVASCULAR TECHNIQUES Single Centre Experience. Ilaria Ficarelli
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1 HYPOGASTRIC ARTERY PRESERVATION DURING EVAR: SURGICAL AND ENDOVASCULAR TECHNIQUES Single Centre Experience Ilaria Ficarelli Service of Vascular Surgery Cardarelli Hospital Naples Chief: Carlo Ruotolo, MD
2 Disclosure Speaker name: Ilaria Ficarelli I have the following potential conflicts of interest to report: Consulting Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s) I do not have any potential conflict of interest
3 HYPOGASTRIC ARTERIES PRESERVATION Background Abdominal aorta aneurysms Associated iliac aneurysms (20-30%) Short common iliac arteries Isolated common iliac aneurysms Iliac bifurcation involvement Hypogastric arteries
4 HYPOGASTRIC ARTERY OCCLUSION Clinical consequences Serious, life-threatening Colonic ischemia Buttock necrosis Spinal cord injury Impredictable, underreported, and disabling Buttock claudication Erectile dysfunction
5 Geraghty PJ. J Vasc Surg 2004;40:413-8 Becquemin JP, JVS 2008; 47: Eagleton MJ. J Vasc Surg 2014;59:89-95
6 HYPOGASTRIC ARTERY OCCLUSION Clinical consequences Serious, life-threatening Colonic ischemia Buttock necrosis Spinal cord injury Impredictable, underreported, and disabling Buttock claudication Erectile dysfunction
7 Jean-Baptiste E. J Vasc Surg 2014;60:40-9 Patients 71 Procedures 75 Acute pelvic ischemia 2 (2.8%) 30-day mortality 3 (4.3%) Buttock claudication 25.3% - 18 months 85%
8 Buttock claudication Jean-Baptiste E. J Vasc Surg 2014;60:40-9 WIQ score p= Persistent Regressive No experience <.0003 Patients 71 Procedures 75 Acute pelvic ischemia 2 (2.8%) 30-day mortality 3 (4.3%) Buttock claudication 25.3% - 18 months 85%
9 HYPOGASTRIC ARTERY PRESERVATION May 2004-September 2018 Patients N=58 Hypogastric artery 66 Surgical revascularization 22 Endovascular techniques 44
10 HYPOGASTRIC ARTERY PRESERVATION Surgical revascularization Patients N=17 Hypogastric artery 22 External-to hypogastric artery bypass 9 Hypogastric artery transposition 13
11 Short common iliac arteries
12 Hypogastric artery-to-external iliac artery transposition
13
14
15
16 HYPOGASTRIC ARTERY PRESERVATION Endovascular techniques Patients N=41 Hypogastric artery 44 Reversed U stent graft technique 1 Nellix EVAS System 2 Bell-bottom technique 8 Double barrell technique 3 Branched devices 30
17 84 years Ectatic right common iliac artery Left common iliac artery aneurysm Bell-bottom technique (2009)
18 24 mm
19 81 years 19 mm Left CIA 18 mm Right CIA
20 Nellix EVAS System
21
22 Right hypogastric artery occlusion 2010
23 Reverse-U stent graft (Fluency 12 X 56 mm)
24
25 DEDICATED BRANCHED DEVICES Dicember 2012-September 2018 Branched devices 30 Cook IBD 6 Gore IBE 24
26 Aneurisma mesenterica superiore 66 years F.E. 30% CIA aneurysms
27 Cook Zenith branched Advanta stent graft
28 Cook bifurcated endograft
29 @ 2 years
30 18 mm 17 mm
31 18 mm
32
33 @ 1 year
34 HYPOGASTRIC ARTERY PRESERVATION Early results 30d Mortality 1/58 (1.7%) Surgical revascularization 22 MI 1/22 (4.5%) EIA dissection/thrombosis 2/22 (9%) Endovascular techniques 44 Technical success 42/44 (95%) MI 1/44 (2.3%) Renal bleeding+cfa occlusion 1/44 (2.3%) Intraoperative hypogastric occlusion 1/44 (2.3%)
35 60 years 2014: AAA open repair (Dacron bifurcated graft) Bilateral double barrell 2 years
36 EIA: Viabhan 13 mm x 10 cm IIA: Viabhan 7 mm x 15 cm
37 EIA: Viabhan 13 mm x 10 cm IIA: Viabhan 7 mm x 15 cm Everflex 7x60 mm
38
39 FOLLOW UP Median follow-up 38 months Patients 58 Survival 50/58 (86%) Hypogastric artery 66 Primary patency 63/66 (95.5%) Hypogastric artery occlusion 3/66 (4.5%)
40 HYPOGASTRIC ARTERY PRESERVATION Conclusions Hypogastric artery occlusion not always benign Hypogastric artery preservation should be considered Younger and more active patients Endovascular techniques First line option Surgical revascularization Fit for surgery Not suitable for endovascular solution
41 HYPOGASTRIC ARTERY PRESERVATION DURING EVAR: SURGICAL AND ENDOVASCULAR TECHNIQUES Single Centre Experience Ilaria Ficarelli Service of Vascular Surgery Cardarelli Hospital Naples Chief: Carlo Ruotolo, MD
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