# Mid-term outcomes of hypogastric artery embolization in endovascular aneurysm repair: a case series

## TL;DR

This study examines mid-term outcomes of hypogastric artery embolization during aortic aneurysm repair, finding a high rate of aneurysm sac expansion.

## Contribution

The study provides new mid-term outcome data on hypogastric artery embolization during EVAR, highlighting elevated sac expansion rates.

## Key findings

- 100% technical success rate with no open conversions or hospital deaths.
- 54.5% of patients experienced sac expansion exceeding 5 mm.
- Freedom from aneurysm expansion decreased to 37.5% at 5 years.

## Abstract

Hypogastric artery embolization is performed during endovascular aneurysm repair (EVAR) involving the common iliac artery. Within this case series, we have observed elevated rates of sac expansion subsequent to this intervention. April 2009 to March 2021, 22 patients underwent EVAR with hypogastric artery embolization. We evaluated the mid-term outcomes for these patients. The mean follow-up period was 57 months. We achieved a 100% technical success rate without open conversion and no hospital deaths. The rates of freedom from aneurysm expansion at 1, 3, and 5 years were 90.5%, 59.1%, and 37.5%, respectively. The percentage of sac expansion exceeding 5 mm was 54.5% (12/22). Combined endovascular aortic aneurysm repair and embolization of the hypogastric artery might be associated with a high rate of remote sac expansion. Larger trials are needed to verify risks and benefits.