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 randomized studies have shown several short-term advantages compared to open surgical repair, including less blood loss, operating time, length of stay, morbidity, and mortality. The long-term ef ficacy of EVAR is dependent upon careful selection of patients with respect to anatomical factors such as excessive angulation, vessel tortuosity, or involvement of visceral or iliac arteries. Although many of these anatomical constraints were previously considered to be relative contraindications to EVAR, technological advances have expanded the indications to include patients with more challenging anatomy. This chapter summarizes the evolution of methods used for preservation of pelvic flow in patients with aortoiliac aneurysms involving one or both common iliac arteries.