Management of Inferior Gluteal Artery-Related Conditions

Clinical Presentation and Diagnosis

• Gluteal claudication typically indicates proximal aortoiliac occlusive disease affecting blood flow to the internal iliac system, characterized by buttock and thigh claudication with diminished femoral pulses or femoral bruit 1, 2, 3
• Bilateral internal iliac artery involvement may cause vasculogenic erectile dysfunction in men 1, 2, 4

Treatment Algorithm

• The American College of Cardiology recommends supervised exercise therapy as initial conservative management for symptomatic aortoiliac disease 5
• The American College of Cardiology suggests pharmacotherapy, such as cilostazol, if no heart failure is present, as part of conservative management 6
• Intervention, such as revascularization, should only be considered if vocational or lifestyle-limiting disability persists despite conservative therapy 7, 8, 9
• Endovascular intervention is preferred for focal aortoiliac disease with a favorable risk-benefit ratio 7, 8
• Stenting is effective as primary therapy for common and external iliac artery stenoses/occlusions 7, 8, 9
• Aortobifemoral bypass is considered for diffuse aortoiliac disease in surgical candidates unresponsive to conservative or endovascular options 1, 7, 3

Critical Pitfalls to Avoid

• Never perform prophylactic intervention in asymptomatic patients, as it provides no benefit and carries unnecessary risk 7, 8, 9, 6
• Bypassing conservative therapy, such as exercise and pharmacotherapy, before revascularization for claudication is not recommended 7, 8, 9