Endovascular Repair of Aortoiliac Aneurysm Using AFX 2 and Iliac Sandwich to Preserve a Hypogastric Artery through a Totally Femoral Access

Preservation of pelvic perfusion during endovascular repair of aortoiliac aneurysmal disease is clinically significant, especially in patients with contralateral internal iliac artery (IIA) occlusion. Although iliac branch devices (IBDs) are effective, their use may be limited by anatomical constraints. This report describes a 76-year-old man with an infrarenal abdominal aortic aneurysm and a left common iliac artery aneurysm, complicated by chronic occlusion of the right IIA and anatomy unsuitable for an IBD. A totally femoral endovascular approach was performed under epidural analgesia, utilizing an AFX 2 endograft and an iliac sandwich technique with overlapping balloon-expandable covered stents to preserve the left IIA. The procedure was technically successful and free of perioperative complications. At 5-year follow-up, imaging demonstrated durable aneurysm exclusion, patent iliac reconstructions, and preserved pelvic perfusion without evidence of ischemic or sexual dysfunction. This case demonstrates a feasible and durable hypogastric-preserving strategy when standard IBDs are unsuitable.