Minimally Invasive Management of Aortoiliac Aneurysms: Outcomes in 12 Patients with Iliac Branch Endografts

BACKGROUND Endovascular aneurysm repair for abdominal aortic and iliac bifurcation aneurysms can require exclusion of both hypogastric arteries, increasing the risk of colonic ischemia, buttock claudication or necrosis, and sexual dysfunction. To mitigate these risks, open surgical reconstruction is often considered; however, a less invasive alternative is the use of a bifurcated iliac side branch endovascular device to preserve hypogastric artery perfusion. This study reports outcomes in 12 high-risk patients with American Society of Anesthesiologists class 3 and 4, with aortic and/or bilateral common iliac artery aneurysms involving the hypogastric origin, treated with this endovascular technique. MATERIAL AND METHODS Twelve patients, aged 62 to 83 years, with high surgical risk underwent endovascular aneurysm repair using iliac side branch devices. Two had prior aorto-iliac bypasses. Preoperative planning included volume-rendered computed tomography angiography. Eleven standard bifurcated endografts and 1 custom device were used. In 10 patients, hypogastric embolization and graft implantation were performed simultaneously; in 2 patients, embolization preceded grafting by 1 month. RESULTS One patient developed occlusion of the left iliac limb and branch graft, requiring femoro-femoral crossover bypass, and later reported erectile dysfunction and buttock claudication. The other 11 patients had successful aneurysm exclusion and maintained hypogastric patency during follow-up. Four patients experienced transient type II endoleaks, which resolved spontaneously within 6 to 12 months. CONCLUSIONS Endovascular repair using iliac side branch devices is a viable, less invasive alternative to open surgery for complex iliac aneurysms. While outcomes are promising, the technique requires advanced expertise and is limited by device cost.