The Importance of the Hypogastric Artery Preservation during Treatment for Aortoiliac Aneurysms: A Prospective Single-Center Study.

BACKGROUND: To determine the importance of the hypogastric artery for the outcomes of survival, endoleaks, reinterventions, buttock claudication (BC), and perioperative mortality rate (PMR) in patients with aortoiliac aneurysms (AIA) receiving endovascular or open surgical (OS) repair. METHODS: This was a prospective consecutive cohort study of patients with AIA who underwent endovascular treatment or OS repair during the period of 2010-2021. Endovascular repair was performed with use of aortoiliac endoprosthesis associated with internal iliac artery (IIA) coil embolization and/or with iliac branch endoprosthesis (IBE) in order to preserve the IIA. The AIA OS repairs were performed with the artery ligation in order to exclude the IIA, or in some cases, the exclusion of the IIA was performed with an endosuture in the proximal stump of the artery. Three groups were identified in the postprocedural period: group 0 (no hypogastric arteries (HAs) preserved), group 1 (1 hypogastric artery preserved), and group 2 (2 hypogastric arteries preserved). RESULTS: A total of 91 patients were submitted to OS or endovascular surgery. Regarding the HA patency, there were 17 patients in group 0, 45 patients in group 1, and 29 patients in group 2. There were 17 cases of bowel ischemia (BI) (94.1% in group 0, 5.9% in group 1, and no cases in group 2, P < 0.001) most of them in group 0, with statistical significance, 12 cases of BC (91.7% in group 0, 8.3% in group 1, and no cases in group 2, P < 0.001), most of them in group 0, with statistical significance. The perioperative mortality was 14.3%, 13 patients (9 patients - 52.9% group 0, 3 patients - 6.7% group 1, and 1 patient - 3.4% group 2, P < 0.001). The linear regression analysis for survival rates showed that BI [P = 0.026 to hazard ratio (HR) = 1.69], emergency aortoiliac repair (P < 0.001, HR = 8.86), and number of HAs (P < 0.001, HR = 5.46) in postoperative were related to poorer survival rates in both univariate and multivariate analysis. The linear regression analysis showed that the number of HAs (P < 0.001, HR = 3.61) in postoperative, emergency aortoiliac repair (P = 0.002, HR 3.233), and cardiac disease (P = 0.048, HR = 3.84) were related to BI. CONCLUSIONS: In conclusion, the number of HA is crucial for adequate and safe outcomes after abdominal aortic aneurysm (AAA) repair. The main factors related to death were BI, emergency aortoiliac repair, and the number of HAs preserved. Moreover, the main factors related to BI were the number of HAs in postoperative, emergency aortoiliac repair, and cardiac disease.

Emergency endovascular repair of aortoiliac aneurysms in COVID-19 times.

In this paper, we describe a case series of four patients who were admitted with emergencies related to aortic aneurysms over a 3-day period and were treated with endovascular repair. The first patient was an 81-year-old female with a history of abdominal pain and a ruptured aortic aneurysm diagnosed by AngioCT-scan. The second patient was a 63-year-old male with a history of oral digestive bleeding and an AngioCT-scan showing an aortoenteric fistula. The third patient was a 77-year-old female with sudden-onset abdominal pain and ruptured right common iliac aneurysm. The fourth patient presented with abdominal pain and an AngioCT-scan showed aortic rupture. All four patients were discharged with no major complications or surgical mortality. These case series show that despite the Covid-19 pandemic situation, since elective surgeries decreased, vascular emergencies have increased.

Relatamos uma série de casos de quatro pacientes consecutivos, admitidos com emergências relacionadas a aneurismas aortoilíacos em um período de 3 dias e submetidos a tratamento endovascular. A primeira paciente, do sexo feminino, com 81 anos e com histórico de aneurisma da aorta, apresentou dor abdominal iniciada nos últimos 12 dias. O segundo paciente era do sexo masculino, com 63 anos e foi admitido com hematêmese 3 dias antes da admissão, com angiotomografia demonstrando fistula aortoentérica. A terceira paciente, do sexo feminino e com 77 anos, foi admitida com quadro de ruptura de aneurisma da artéria ilíaca comum direita. O quarto paciente consecutivo apresentou dor abdominal iniciada 2 semanas antes da internação e aneurisma roto da aorta. Todos os quatro pacientes apresentaram emergências aortoilíacas e receberam alta sem complicações maiores ou mortalidade cirúrgica. O relato desta série de casos demonstra que, apesar da situação pandêmica da COVID-19, uma vez que as cirurgias eletivas diminuíram, as urgências vasculares aumentaram.

Emergency endovascular repair of aortoiliac aneurysms in COVID-19 times / Tratamento endovascular das emergências dos aneurismas aortoilíacos em tempos de COVID-19

Abstract In this paper, we describe a case series of four patients who were admitted with emergencies related to aortic aneurysms over a 3-day period and were treated with endovascular repair. The first patient was an 81-year-old female with a history of abdominal pain and a ruptured aortic aneurysm diagnosed by AngioCT-scan. The second patient was a 63-year-old male with a history of oral digestive bleeding and an AngioCT-scan showing an aortoenteric fistula. The third patient was a 77-year-old female with sudden-onset abdominal pain and ruptured right common iliac aneurysm. The fourth patient presented with abdominal pain and an AngioCT-scan showed aortic rupture. All four patients were discharged with no major complications or surgical mortality. These case series show that despite the Covid-19 pandemic situation, since elective surgeries decreased, vascular emergencies have increased.

Resumo Relatamos uma série de casos de quatro pacientes consecutivos, admitidos com emergências relacionadas a aneurismas aortoilíacos em um período de 3 dias e submetidos a tratamento endovascular. A primeira paciente, do sexo feminino, com 81 anos e com histórico de aneurisma da aorta, apresentou dor abdominal iniciada nos últimos 12 dias. O segundo paciente era do sexo masculino, com 63 anos e foi admitido com hematêmese 3 dias antes da admissão, com angiotomografia demonstrando fistula aortoentérica. A terceira paciente, do sexo feminino e com 77 anos, foi admitida com quadro de ruptura de aneurisma da artéria ilíaca comum direita. O quarto paciente consecutivo apresentou dor abdominal iniciada 2 semanas antes da internação e aneurisma roto da aorta. Todos os quatro pacientes apresentaram emergências aortoilíacas e receberam alta sem complicações maiores ou mortalidade cirúrgica. O relato desta série de casos demonstra que, apesar da situação pandêmica da COVID-19, uma vez que as cirurgias eletivas diminuíram, as urgências vasculares aumentaram.