A technique for combined hypogastric artery bypass and endovascular repair of complex aortoiliac aneurysms

Endovascular repair of complex aortoiliac aneurysms may necessitate distal fixation of the endograft to the external iliac artery and percutaneous embolization of the hypogastric artery for prevention of a retrograde endoleak. However, acute interruption of hypogastric perfusion can result in symptoms of pelvic ischemia. We describe a technique in which a prosthetic graft is used as an external iliac artery conduit to facilitate the passage of the endograft delivery catheter/sheath and after completion of the endovascular portion of the procedure, a surgical bypass is completed with anastomosis of the graft to the hypogastric artery.