Gianbattista Parlani, MD, is a vascular surgeon at the hospital S. Maria della Misericordia in Peruggia, Italy. Dr. Parlani shares his experience after 10 years preserving the hypogastric artery.
Which patient population do you treat with hypogastric preservation?
Our policy was always to preserve the hypogastric artery. If we have a patient with an abdominal aortic aneurysm associated with a common iliac aneurysm or hypogastric aneurysm, and an iliac branch device it is feasible, we shift to this kind of procedure instead of embolizing the artery. The risk of buttock claudication is very high and we prefer to save the hypogastric artery in our patients.
The policy is always try to preserve the artery. Independent from the age of the patient, their only criterion is the anatomical requirement. If the patient is fit for the iliac branch device, we do this kind of procedure.
Why do you choose to preserve the hypogastric artery?
We want to avoid buttock claudication. Although severe complications like buttock necrosis or bowel ischaemia are rare after embolization of one hypogastric artery, the buttock claudication is about 50% of patients. It is not a negligible complication for patients.
What would you say are the most important factors for durability when you’re thinking about treating with an iliac branch device?
The anatomical findings of the patient. If you want a durable procedure you must avoid diseased hypogastric arteries, and excessive tortuosity and calcification in vessel.
How has your practice changed over time?
It has changed. 10 years ago, when we didn’t have this kind of technology available, we embolized the artery; we made the bellbottom technique for the ectatic iliac artery. But now, our policy is to treat every kind of patient with the iliac branch device. We avoid using larger limbs, more than 22 mm. If we have 23 or 24 mm iliac artery we put an IBD.
Do you have any advice for trainees coming out of their programs that may not have experience with iliac branch devices?
I think if you perform 50 EVARs, you are able to perform an IBD because the risk of the procedure failing is not so high. To lose a hypogastric artery is not like losing a renal artery or mesenteric artery. If you have a failure, it is not a big problem. It is also a good case for starting an advanced endovascular abdominal aortic program.
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