Endovascular Treatment for Symptomatic Hypogastric Artery Stenosis or Occlusion: A Systematic Review and Meta-Analysis

ABSTRACT Background This systematic review and meta-analysis aimed to evaluate indications, techniques, and outcomes of endovascular treatment for symptomatic hypogastric artery lesions. Data Source A systematic literature search (PubMed, Web of Science, Scopus, Cochrane Library) following PRISMA guidelines was performed (PROSPERO registration number CRD420251232230). Methods Studies including at least five cases of symptomatic hypogastric artery lesions, treated with endovascular technique, were included. Primary outcomes were technical success (TS) and clinical success (CS). Secondary endpoints included patency, reintervention and complications. Meta-analyses of proportions were performed using a random-effects model. Results Six studies comprising 95 patients and 117 treated hypogastric arteries were included. Mean age was 67.46 years (95% CI 65.3-69.6; P=.018), and 89.9% of patients (95% CI 83.9-95.8; P=.775) were male. The hypogastric lesions were predominantly unilateral 72.5% (95% CI 53-91.9; P<.001) and stenosis 89.5% (95% CI 80.9-98.2; P=.013). Percutaneous Transluminal Angioplasty was used in 54.1% (95% CI 16.6-91.5; P<.01) of cases, stent placement in 45.9% (95% CI 8.5-83.4; P<0.1). TS was 96.1% (95% CI 92.6-99.5; P=.860). Post-operative CS was achieved in 90.4% (95% CI 82.8.-98.1; P=.114), with complete symptom resolution in 83.9% (95% CI 70.1-97.8; P<.001). Mean follow-up was 12.57 months (95% CI 4.39-20.7; P<.001). Estimated primary-patency rate was 93.4% (95% CI 87.5-99.3; P=.081). Reintervention was required in 4.3% (95% CI 0.8-7.9; P=.477) of patients. No peri-operative or follow-up mortality was reported. Conclusions Endovascular treatment of symptomatic hypogastric steno-occlusive lesions is safe, technically feasible, and associated with high CS and excellent mid-term patency, with minimal morbidity and no reported post-operative mortality.