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Internal Iliac Artery Bypass in Nice

Dr. Ilya Khantalin, Vascular Surgeon in the Alpes-Maritimes

Internal Iliac Artery Bypass

Dr. Ilya Khantalin in Nice

The internal iliac artery bypass is a vascular surgical procedure used to treat conditions caused by an obstruction or stenosis of the primary arteries supplying the pelvis, specifically the internal iliac arteries. This type of bypass aims to restore adequate blood flow and prevent severe complications such as erectile dysfunction or pelvic ischemia.

Endovascular techniques are now the most modern and commonly used approaches by vascular surgeons, in accordance with the recommendations of the French Haute Autorité de Santé and standardized surgical protocols.

Vascular diseases are recognized as Long-Term Conditions (Affections de Longue Durée – ALD), which allows for 100% reimbursement by the French Social Security system.

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What is an internal iliac artery bypass?

Vascular Surgeon in Saint-Laurent-Du-Var

An internal iliac artery bypass is a vascular surgery procedure designed to restore blood flow in the pelvic region, particularly through the internal iliac artery (also known as the hypogastric artery). This artery supplies various pelvic organs and tissues, including those essential for erectile function.

Dysfunction or obstruction of this artery can result in circulatory issues directly affecting erectile quality. This bypass is considered for patients experiencing internal iliac artery obstruction leading to erectile dysfunction.

Indications, Benefits, and Procedure of Internal Iliac Artery Bypass

Vascular Surgery Specialist in Saint-Laurent-Du-Var

The main indications for an internal iliac artery bypass include:

  • Documented vascular erectile dysfunction: In some patients, erectile dysfunction results directly from poor blood supply to the pelvic organs due to internal iliac artery obstruction.
  • Severe obstruction of the internal iliac artery: If this causes symptoms such as pelvic pain, ischemic colitis signs, rectal bleeding, or erectile dysfunction, bypass surgery may be indicated.
  • Failure of medical treatment: When pharmacological or non-invasive treatments for erectile dysfunction fail and a vascular cause is identified, bypass surgery may be a valid therapeutic option.
  • Preservation of erectile function during aortic surgery: Sometimes, bypass is performed to maintain pelvic perfusion during major procedures such as aorto-iliac bypass or abdominal aortic aneurysm repair.

The main objective is to restore optimal blood flow in the pelvic area to relieve symptoms caused by vascular insufficiency of the internal iliac artery. Restoring circulation can help:

  • Prevent colonic ischemia: Reestablishing blood flow reduces the risk of ischemia to the colon and sigmoid.
  • Improve erectile function: Enhanced pelvic perfusion can help resolve erectile dysfunction linked to poor blood supply.
  • Alleviate pelvic pain: Pelvic or exertional pain due to arterial blockages may decrease with improved blood flow.
  • Preserve global pelvic function: Adequate circulation helps maintain the proper function of various pelvic organs, contributing to better overall quality of life.

Internal iliac artery bypass is a complex surgery requiring vascular expertise. It can be performed under general or regional anesthesia depending on the patient’s condition and clinical context.

  • Preoperative testing: Imaging studies such as angiography are used to precisely locate the blockage and evaluate vessel condition.
  • Graft technique: A vascular graft (autologous or synthetic) is used to bypass the blockage and restore flow.
  • Operation duration: The surgery typically lasts 2 to 4 hours depending on anatomical complexity.

A rigorous postoperative follow-up is essential to ensure a successful outcome and avoid complications.

  • Hospitalization: A few days of inpatient care is usually required to monitor healing and blood flow restoration.
  • Anticoagulant therapy: Prescribed to prevent clot formation in the graft and reduce the risk of thrombosis.
  • Regular vascular follow-up: Imaging studies (Doppler ultrasound, CT angiography) monitor graft patency and detect possible issues.
  • Rehabilitation: A gradual return to activity is encouraged. Strenuous exercise is avoided in the early weeks.

Although individual outcomes vary, studies show that internal iliac artery bypass can significantly improve erectile dysfunction of vascular origin. Restored blood flow often results in better erectile response when dysfunction was related to pelvic arterial insufficiency.

Success depends on multiple factors:

  • Overall vascular health: Patients with better vascular status generally experience superior results.
  • Lifestyle quality: Smoking cessation, weight management, and physical activity all enhance long-term outcomes.

As with any surgical intervention, risks are present:

  • Infection: Rare but possible at the surgical site or graft.
  • Graft thrombosis: Minimized by anticoagulation and close monitoring.
  • Hematoma: Postoperative bleeding may cause hematoma requiring observation.

These risks are generally well-managed with advanced surgical techniques and vigilant postoperative care.

Internal iliac artery bypass is an effective treatment for erectile dysfunction of vascular origin due to arterial obstruction. By restoring proper blood flow to the pelvic region, this procedure not only improves erectile function but also preserves overall pelvic organ health. With specialized care and appropriate follow-up, the procedure can significantly enhance patients’ quality of life.

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