Pelvic collateral pathway during endovascular aortoiliac aneurysm repair with internal iliac artery interruption: a retrospective observational study

Masahiro Itoh,Yoshihiro Suematsu,Satoshi Nishi,Shinichi Kawata,Shogo Hayashi,Takuya Omotehara

doi:10.1186/s12872-020-01764-y

Abstract

BackgroundIpsilateral branches of the deep femoral artery (DFA) are qualitatively identified as collateral arteries based on angiography after internal iliac artery (IIA) interruption. The purpose of this study was to quantitatively identify the major collateral pathway after unilateral IIA interruption during endovascular aortoiliac aneurysm repair to preserve the pelvic circulation and reduce the risk of ischemic complications.MethodsThe study population included 28 patients (mean age 76.3 years) with aortoiliac aneurysm who underwent endovascular aneurysm repair with unilateral IIA interruption from August 2012 to January 2020. The diameters of the bilateral preoperative and postoperative DFA, lateral femoral circumflex artery (LFCA), medial femoral circumflex artery (MFCA) and obturator artery (ObA) were measured on contrast-enhanced computed tomography using a 3-dimensional image analysis system. The measured values were evaluated and analyzed with a repeated measures two-way analysis of variance and Dunnett’s test.ResultsThe postoperative diameters of the MFCA (P = 0.051) and ObA (P = 0.016) were observed to be larger than the preoperative diameters. Such increases in the MFCA (P < 0.001) and ObA (P < 0.001) diameters were only found to be significant on the unilateral side of the IIA interruption, and the diameter of the ipsilateral LFCA (P < 0.001) was also found to have significantly increased in size. However, no significant arterial extension was found on the contralateral side.ConclusionsThe ipsilateral MFCA-ObA pathway might therefore be a major collateral pathway arising from the DFA to preserve pelvic circulation after unilateral IIA interruption.

Highlights

Ipsilateral branches of the deep femoral artery (DFA) are qualitatively identified as collateral arteries based on angiography after internal iliac artery (IIA) interruption
The medial femoral circumflex artery (MFCA) terminates in the obturator artery (ObA), a branch of the IIA, whereas the lateral femoral circumflex artery (LFCA) directly supplies the gluteal muscles of the buttocks [3]
Ipsi Contra mm Discussion We showed that the diameter of the MFCA tended to extend and that the diameter of the ObA was significantly extended after unilateral IIA interruption, regardless of the position of the MFCA or LFCA

Summary

Introduction

Ipsilateral branches of the deep femoral artery (DFA) are qualitatively identified as collateral arteries based on angiography after internal iliac artery (IIA) interruption. The internal iliac artery (IIA) is the major blood supply to the pelvic organs and buttock muscles. The inferior gluteal artery, which supplies the lower part of the gluteus maximus, and the obturator artery (ObA) which originates from the anterior division of the IIA [2]. The lateral femoral circumflex artery (LFCA) and medial femoral circumflex artery (MFCA) originating from the deep femoral artery (DFA) or FA provide this collateral pathway to the pelvic girdle. The MFCA terminates in the ObA, a branch of the IIA, whereas the LFCA directly supplies the gluteal muscles of the buttocks [3]

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