Pelvic revascularization during endovascular aortic aneurysm repair

Endovascular repair of aortic aneurysms (EVAR) has gained widespread acceptance in the treatment of abdominal aortic aneurysms (AAAs). Prospective studies have shown advantages compared with open surgical repair, including decreased blood loss, operating time, hospital stay, morbidity, and mortality. Approximately 30% of patients treated by EVAR have ectatic or aneurysmal common iliac arteries not suitable for distal sealing zones. In these patients, one of the most commonly utilized options is exclusion of the internal iliac artery (IIA). Decreased pelvic perfusion carries the risk of ischemic complications, including buttock claudication, sexual dysfunction, and other devastating complications such as spinal cord injury, ischemic colitis, and gluteal muscle necrosis. This article summarizes the methods of pelvic revascularization in patients with aortoiliac aneurysms involving one or both common iliac arteries.