Intentional internal iliac artery occlusion in endovascular repair of abdominal aortic aneurysms

Endoluminal grafting of aortoiliac aneurysms is an evolving technology. Since many lesions involve part of all of the common iliac arteries, it may be necessary to cover the internal iliac (hypogastric) arteries. Since the internal iliac arteries are important for flow to pelvic organs and perhaps the colon, their sacrifice may not be innocuous, especially since reimplantation of the inferior mesenteric artery is not possible during endovascular aneurysm repair. Most series reflect the relative safety of unilateral internal iliac artery sacrifice. Bilateral hypogastric artery sacrifice, especially if not staged temporally, may cause more significant complications. The incidence of claudication and impotence remains significant, prompting some to recommend revascularization of at least one internal iliac artery at the time of aneurysm repair in order to preserve one of these important vessels. Such an internal iliac artery bypass can be simply performed during endovascular aneurysm repair. The development of larger, more precisely deployed iliac limbs as well as the development of branched devices should decrease the need for internal iliac artery sacrifice.