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Consequences of Hypogastric Artery Embolization, Ligation or Coverage in Vascular, ObGyn , Oncology and Trauma Patients
Gautham Chitragari, MBBS, Felix J. Schlosser, MD, Ph.D, Bauer E. Sumpio, MD, Ph.D.
Yale University School of Medicine, New Haven, CT, USA.
BACKGROUND
Ligation, coverage or embolization(LCE) of the hypogastric artery (HGA) may result in ischemic complications. The aim of this study was to compare the rate and the risk factors for the development of ischemic complications after LCE of HGA in ObGyn, Vascular, oncology (ONC) and trauma patients.
METHODS
Databases were searched for articles containing data of patients who underwent LCE of HGA. Based on the indication, details of the procedure and complications developed, data collected was categorized and evaluated for any significant difference in outcome using chi-square test.
RESULTS
121 papers and a total of 335 patients ( mean age - 49.2 years; median-44 years) were included in the study. 30.7%(103/335) were male, 69.3%(232/335) were female. Indication for LCE was ObGyn related in 51.0%(171/335), vascular in 26.0%(87/335), ONC in 18.0%(60/335) and trauma in 5.0%(17/335) of patients Overall ischemic complication rate was 23.0%(77/335), including buttock claudication(12.2%), buttock necrosis(5.4%), lower limb ischemia(3.6%), spinal cord ischemia(3.3%), erectile dysfunction(2.9%) and colon ischemia(2.7%). Complication rate was 8.6%(10/116) after ligation, 31.4%(65/207) after embolization (p=0.01) and 25.0%(3/12) after covering of HGA. 32.3%(30/93) patients with unilateral LCE (mostly embolizations) of HGA developed complications compared with 19.8% of patients with bilateral LCE (mostly ligations)(p=0.07). Complications were fewer in patients aged 44 years (35%; 57/160; p=0.001). LCE of the origin of HGA produced less complications, 19.4%(48/247), compared to LCE of distal branches 69.2%(p<0.001). The use of gelfoam (28.6%), coils (35.5%) or Amplatzer plugs (33.3%) produced similar rate of complications(p=NS). Patients with vascular (38.2%), ObGyn (7.6%), ONC (35.6%) or trauma (62.5%) indications had different complication rates. The difference in complication rate between vascular and ObGyn patients was statistically significant (p<0.001).
CONCLUSIONS
Ischemic complications after LCE of the HGA depends on the indications, age and type of intervention. In patients older than 44 years, LCE of HGA should be done with caution. Proximal embolization is preferred over distal embolization and ligation of proximal HGA is preferred over embolization.
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