A new strategy for open surgery of giant aortoiliac aneurysms with preservation of the hypogastric artery.

Purpose: We present a new approach for open surgical repair of giant aortoiliac (AI) aneurysms that prioritizes preservation of the hypogastric artery (HA). In cases where the aneurysm extends to the iliac bifurcation and involves both HAs, traditional open repair techniques often require an aortobifemoral bypass with HA exclusion, posing challenges for maintaining pelvic perfusion.

Methods: A retrospective analysis of 10 patients treated between 07/2021 and 07/2023 was conducted. The aneurysms extended to both HA in all cases. Patients were followed up at 30-day and in 6-month intervals thereafter. A total of 10 HA revascularization procedures were performed in 10 patients undergoing open surgical AI aneurysms repair (9 men and 1 woman; median age 68 [65; 70] years). Six-mm polyester grafts were used for aortic tube graft to HA bypass in 10 cases.

Results: Successful open surgical repair of giant AI aneurysms, including those involving the iliac bifurcation, was achieved in all cases. There was one case of perioperative myocardial infarction with pulmonary edema. No instances of gluteal claudication, colon ischemia, or perineal ischemia were observed. Eight patients reported no change in sexual function, while one patient experienced a reduction in erectile function. One patient died in the ICU 2 weeks postoperatively. During a follow-up period of 6-18 months, graft patency was maintained in nine patients.

Conclusion: An additional branch to the HA can reliably maintain pelvic circulation in the short to intermediate term, helping to prevent ischemia in patients requiring extended open surgical repair that involves both HAs.