Implications of concomitant hypogastric artery embolization with endovascular repair of infrarenal abdominal aortic aneurysms

Objective: Hypogastric artery embolization (HAE) is associated with significant risk of ischemic complications. We assessed the impact of HAE on 30-day outcomes of endovascular aneurysm repair (EVAR) of infrarenal abdominal aortic aneurysms. Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2014 to identify and to compare clinical features, operative details, and 30-day outcomes of EVAR with those of concomitant HAE with EVAR (HAE + EVAR). Multivariate analysis was performed to determine preoperative and intraoperative factors associated with development of significant complications observed in patients with HAE + EVAR. Results: In a cohort of 5881 patients, 387 (6.6%) underwent HAE + EVAR. Compared with EVAR, a higher incidence of ischemic colitis (2.6% vs 0.9%; P =.002), renal failure requiring dialysis (2.8% vs 1%; P =.001), pneumonia (2.6% vs 1.3%; P =.039), and perioperative blood transfusion (17% vs 13%; P =.024) was noted after HAE + EVAR. Thirty-day thromboembolic events, strokes, myocardial infarction, lower extremity ischemia, reoperation, and readmission rates were not significantly different (P >.05). Mortality at 30 days in HAE + EVAR patients was 4.1% compared with 2.5% with EVAR (P =.044). HAE was independently associated with increased risk of colonic ischemia (adjusted odds ratio, 2.98; 95% confidence interval, 1.44-6.14; P =.003) and renal failure requiring dialysis (adjusted odds ratio, 2.22; 95% confidence interval, 1.09-4.53; P =.029). However, HAE was not an independent predictor of mortality. Average length of hospital stay was 4 +/- 8.5 days after HAE + EVAR vs 3.3 +/- 5.9 days after EVAR (P =.001). Conclusions: Concomitant HAE with EVAR is associated with longer and more complicated hospital stays. Ischemic colitis is a rare complication of EVAR. HAE increases the risk of ischemic colitis and renal failure requiring dialysis. This study highlights the importance of hypogastric artery preservation during EVAR.