Results of reconstructive operations on the internal iliac arteries pool in the treatment of patients with buttock claudication

The OBJECTIVE was to analyze the results of open and endovascular reconstructive operations in the internal iliac arteries pool in the treatment of patients with buttock claudication.

METHODS AND MATERIALS. The retrospective study included 53 patients aged from 40 to 77 years (mean age 63.9±7.7 years) with chronic lower limb ischemia of stage IIb (according to Fontaine – Pokrovsky), who underwent open or endovascular reconstructive surgery on one or both of the internal iliac and/or gluteal arteries in the Department of Vascular Surgery at the Pavlov Moscow State Medical University in the period from 2020 to 2025 for occlusive stenotic lesions in order to treat buttock claudication.

RESULTS. 66 operations (56 endovascular and 10 open) were performed in 53 patients. The patency of stented arteries after endovascular reconstructions by the time of discharge from the hospital was 100%, and that of open implanted vascular conduits was 50%. Among 30 (68%) of patients surveyed in the late period after surgery, 21 (70%) patients reported a positive treatment result in the form of relief or reduction of buttock claudication with an increase in pain-free walking distance. The reasons for the unsatisfactory result according to the computed tomography data were thrombosis of reconstruction zone, residual occlusion or stenosis of the gluteal artery or atherosclerotic changes progression of the lower extremities arteries. We established that the 1- and 3-year patency of the operated internal iliac artery bed is 91 % and 61%, respectively. Transcutaneous oximetry among patients, most of whom had a positive treatment result, showed a statistically significant increase in their exercise tolerance test and transcutaneous oxygen pressure of the gluteal regions.

CONCLUSION. Achieving a positive clinical result in 70 % of the surveyed patients indicates both the need for further study of diagnostic methods and treatment tactics for buttock claudication, and the possibility of wider application in clinical practice of reconstructive surgery in patients with occlusive-stenotic lesions of the internal iliac arteries and their branches.

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