Hypogastric artery bypass to preserve pelvic circulation: improved outcome after XXXX repair.

@entity1 @entity190 @entity19138 @entity439 @entity613 @entity717 @entity1029 @entity1028
OBJECTIVE: This study was carried out to compare the functional outcomes after @entity19138 artery bypass and coil embolization for management of common @entity1029 in the endovascular repair of @entity439 (EVAR). METHODS: Between 1996 and 2002, 265 @entity1 underwent elective or emergent EVAR. Data were retrospectively reviewed for 21 (8%) @entity1 with @entity1029 25 mm or larger that involved the iliac bifurcation. @entity1 underwent @entity19138 artery bypass (n = 9) or coil embolization (n = 12). Interviews about past and current levels of activity were conducted. A @entity717 ( @entity717 ) was quantitatively graded on a discrete scale ranging from 0 to 10, corresponding to "virtually bed-bound" to exercise tolerance "greater than a mile." Worsening or improvement of symptoms was expressed as a difference in @entity717 between two time points (-, worsening; +, improvement). RESULTS: There was no difference in age (72.6 +/- 7.3 years vs 73.1 +/- 6.4 years), sex (male-female ratio, 8:1 vs 11:1), @entity1028 size (60.1 +/- 5.9 mm vs 59.3 +/- 7.0 mm), or number of preoperative comorbid conditions (1.9 +/- 0.8 vs 2.1 +/- 0.8) between @entity19138 bypass and coil embolization groups, respectively. Mean follow-up was shorter after @entity19138 bypass (14.8 vs 20.5 months; P <.05). There was no difference in the mean overall baseline @entity717 between the bypass and the embolization groups (8.0 vs 7.8). Six (50%) of the 12 @entity1 with coil embolization reported symptoms of @entity613 ipsilateral to the occluded @entity19138 artery. No symptoms of @entity613 were reported after @entity19138 bypass (P <.05). There was a decrease in the @entity717 after both procedures; however, coil embolization was associated with a significantly worse @entity717 compared with @entity19138 artery bypass (4.5 vs 7.3; P <.001). In 4 (67%) of 6 @entity1 with @entity613 after coil embolization symptoms improved, with a @entity717 of 5.4 at last follow-up. This was significantly worse than in @entity1 undergoing @entity19138 artery bypass, with a @entity717 of 7.8 at last follow-up (P <.001). There was no difference between the groups in duration of procedure, @entity190 , length of hospital stay, morbidity, or mortality (0%). CONCLUSIONS: Hypogastric artery bypass to preserve pelvic circulation is safe, and significantly decreases the risk for @entity613 . Preservation of pelvic circulation results in significant improvement in the ambulatory status of @entity1 with common @entity1029 , compared with coil embolization.
