Quality of Life and aortobifemoral bypass – Importance of the hypogastric arteries
C. Braz, , R. Castro-Ferreira, P. Dias, S. Sampaio, J. Teixeira
Faculdade de Medicina da Universidade do Porto, Portugal

Aim: Evaluate SD after AFB and assess the importance of patent hypogastric arteries before the procedure.

Introduction: The aortobifemoral bypass (AFB) is one of the best options to revascularize patients with Aortoiliac Occlusive Disease (AIOD). The impact of this procedure in sexual function (SF) is unpredictable, with 20–80% of the patients reporting sexual dysfunction (SD) after surgery. There's still insufficient data to safely predict the development of SD after AFB and what the role of hypogastric arteries.

Methods: The study includes only male population submitted to AFB due to AIOD. Patients with major amputations after the surgery were excluded. The development of SD was evaluated by phone call. The quality of life before and after the procedure was evaluated by a standardized index score questionnaire (15D). Pre-operative patency of hypogastric arteries was appraised by assessing the patients imaging file. The arteries with direct anterograde flow were considered patent.

Results: Of a total of 53 patients, 40 were included in the study – exclusion causes were intrahospital death, natural cause death and major amputation. In the included group, 37% reported worsening, 26% improved and 37% did not notice any change in SF after surgery. If at least one of the hypogastric arteries was patent before surgery, 58% described worsening in SF compared to only 13% in the group with no sustained anterograde flow to the hypogastric arteries. 92% of the patients was not warned of the possibility of SD after surgery, being that 26% of these would have refused the procedure if they knew.

Conclusion: SD is a prevalent and often overlooked complication after open aortoiliac revascularization and it remains a major taboo in the surgeon/patient relation. The existence of at least one hypogastric artery with preserved anterograde flow before surgery can strongly predict a higher risk of sexual dysfunction after surgery.

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