Preservation of pelvic circulation with hypogastric artery bypass in endovascular repair of abdominal aortic aneurysm with bilateral iliac artery aneurysms

A, Preoperative angiography of abdominal aortic aneurysm with the bilateral common iliac artery aneurysm. B, Postoperative angiography shows both patent hypogastric artery bypass (white arrow) and hypogastric artery (black arrow) with aortouni-external iliac stent graft.

Time points of pelvic hemodynamics during endovascular aneurysm repair and hypogastric artery (HA) bypass. A, Time point A: before HA flow interruption. B, Time point B: after interruption of contralateral HA flow with coil embolization. C, Time point C: after bilateral interruption of both HA and external iliac artery (EIA) flow. D, Time point D: after revascularization of EIA with interruption of bilateral HA flow and contralateral EIA flow. E, Time point E: after revascularization of bilateral EIA with interruption of bilateral HA flow. F, Time point F: after revascularization of ipsilateral HA with interruption of contralateral HA flow.

Changes in penile brachial pressure index (PBI) during endovascular aneurysm repair and hypogastric artery (HA) bypass. A, Before HA flow interruption; B, after interruption of contralateral HA flow with coil embolization; C, after bilateral interruption of both HA and external iliac artery (EIA) flow; D, after revascularization of ipsilateral EIA with interruption of both bilateral HA flow and contralateral EIA flow; E, after revascularization of bilateral EIA with interruption of bilateral HA flow; and F, after revascularization of the ipsilateral HA with interruption of contralateral HA flow. Data are expressed as mean ± SD. *P < .05 vs time point A.

Changes in tissue oxygenation index (TOI) measured by near-infrared spectroscopy on the buttock ipsilateral to the aortouni-EIA stent graft (ipsilateral) and on the contralateral buttock (contralateral). A, Before HA flow interruption; B, after interruption of contralateral HA flow with coil embolization; C, after bilateral interruption of both HA and external iliac artery (EIA) flow; D, after revascularization of ipsilateral EIA with interruption of both bilateral HA flow and contralateral EIA flow; E, after revascularization of bilateral EIA with interruption of bilateral HA flow; and F, after revascularization of the ipsilateral HA with interruption of contralateral HA flow. Data are expressed as mean ± SD. *P < .05 vs time point A on the same side. ^#P < .05 vs the buttock on the ipsilateral side at the same time point.