We performed several arterial reconstruction methods for five patients with buttock claudication due to ischemia of the hypogastric artery, and their symptoms improved remarkably. They had complained of severe buttock pain, although every patients' ankle brachial pressure index had almost been within the normal range. Angiography had showed not only hypogastric arterial stenosis but extensive sclerotic changes of pelvic arteries. Two cases had had contralateral iliac stenosis. We placed stress on reconstruction for the main trunks to supply the lower extremities with sufficient blood flow, and occasionally reconstructed the hypogastric artery in addition. Aorto-femoral bypass, ilio-femoral bypass, Y-graft replacement, atherectomy were performed, among other procedures. The buttock pain was eliminated. Buttock claudication, caused by critical hypogastric circulation, occurs only when blood flow through the pelvic collateral vessels is compromised. In particular, the principal etiology seems to be blood flow steal to the ischemic legs on exercise. In such cases, arterial reconstruction of the lower extremities is very effective.

Ischemic heart disease (IHD) poses a major complicating factor for abdominal aortic aneurysm (AAA) repair. To identify patients with IHD, we evaluated patients scheduled to undergo AAA repair with dipyridamole-thallium scintigraphy (DTS) and coronary angiography (CAG). If indicated, coronary revascularization was performed. Finally, an assessment of the effectiveness of these preventive measures was made. One hundred and ten patients scheduled to undergo AAA repair were identified and treated accordingly over a 20-year period. As the pre-operative evaluation and prophylactic surgical revascularization strategies were instituted in 1983, the patients were divided into 2 groups: 25 patients between 1973-1982 (group A) and 85 patients between 1983-1992 (group B). The mean age of patients in group A was 65.3 years. The male/female ratio within this group was 21:4. One patient in the group had a history of IHD and 9 had hypertention. The mean age of patients in group B was 67.7 years. The male/female ratio within this group was 77:8. Fourteen patients in this group had a history of IHD and 27 had hypertension. Screening and treatment of IHD in group B was as follows. All patients with a history of IHD underwent CAG. Of the 32 patients with cardiac risk factors, including hypertension and hyperlipidemia, or ECG abnormalities who underwent DTS, 8 were referred for CAG. Thirty-nine patients with no risk factors and a normal ECG proceeded to AAA repair without further workup. Perioperative myocardial infarction occurred in 2 patients in grouzp A, leading to death in 1 patient. Coronary revascularization was performed in 5 patients in group B. No perioperative myocardial infarction occurred in this group. Pre-operative identification of high-risk cases with DTS, CAG, and coronary revascularization in patients with IHD may prevent cardiovascular complications in patients undergoing AAA repair.