Abstract 16429: Questioning the Effect of Hypogastric Artery Exclusion on Erectile Function Following Endovascular Repair of Abdominal Aortic Aneurysm

Introduction: Published reports suggest negative effect of exclusion of antegrade hypogastric artery flow on erectile function after endovascular aneurysm repair (EVR). This has stimulated new branched device development and off-label and open surgical hybrid procedures, trying to maintain antegrade pelvic perfusion in EVR patients. However, proof is lacking that such efforts have positive influence on clinical outcomes with respect to erectile function. Hypothesis: We hypothesized that, when analyzed 60 months postoperatively, there would be no difference in patient-reported erectile function outcomes when compared between patients with and without maintenance of bilateral antegrade pelvic perfusion following EVR. Methods: OVER trial patients were all male and had erectile function assessed at multiple time points by administration of the IIEF-5 questionnaire. Bayesian hierarchical regression models were created with the outcome variable (erectile function) treated as a latent variable. Primary effects of differences in erectile function between groups with and without preservation of bilateral antegrade hypogastric flow were compared. In addition to visual inspection of the posterior predictive distribution, model convergence was assessed by maximum Gelman-Rubin statistic <1.001. Results: 252 men from the EVR arm of the OVER trial were included in the analysis. Of these, 202 underwent a repair which maintained bilateral antegrade pelvic flow while 50 did not preserve both hypogastrics. After adjustment for baseline score, age, beta blocker use, ejection fraction, preoperative ABIs and time, loss of bilateral antegrade hypogastric perfusion was not associated with a significant difference in IIEF score compared to maintenance of antegrade perfusion (score change: -0.065; 95% CI: -0.239, 0.109). Conclusions: This is the largest aneurysm treatment trial to prospectively collect data on erectile function. There is no evidence that decreased erectile function is mitigated by preservation of antegrade hypogastric flow. Additional radiation exposure and resource utilization for this purpose may be unnecessary.