TREATMENT OF HYPOGASTRIC ARTERIES IN ENDOVASCULAR SURGERY FOR ABDOMINAL AORTIC ANEURYSMS

Introduction. Endovascular repair of the abdominal aortic aneurysm (EVAR) is bringing about a change in the therapeutic procedures used in vascular surgery. The fact that it is less invasive means that it is especially indicated in high surgical risk patients. The anatomy of the aneurysm often has to be modified to make it compatible with EVAR. The most common procedure consists in excluding the hypogastric arteries (HA), particularly in the presence of iliac aneurysms. By so doing, type II endoleaks due to re-entry from the HA can be avoided. Aim. To further our knowledge of the techniques for excluding HA, their outcomes, complications and the aetiopathogenesis of secondary pelvic ischaemia. Development. The most significant results found in an analysis of the literature published on these issues are as follows: in almost 15% of patients who are candidates for EVAR it must be taken into account that at least one HA will have to be excluded; the exclusion of the HA, even if it is bilateral, is not followed by the catastrophic consequences observed in open surgery; pelvic collaterality is essentially ipsilateral; buttock claudication is the most frequent complication; and simple coverage is safe and effective. Conclusions. The exclusion of one or both HA increases the percentage of patients who are candidates for EVAR, but raises the rate of ischaemic complications they experience.