Endovascular Exclusion of Hypogastric Aneurysms Using Distal Branches of the Internal Iliac Artery as Landing Zone: A Case Series

Background: The purpose of the study was to report an alternative endovascular technique to exclude aneurysms of the internal iliac artery in the setting of abdominal aortic aneurysm (AAA) disease using the anterior division of the hypogastric artery (HGA) or the superior gluteal artery (SGA) as distal landing zone for the stent graft. Methods: Three patients with HGA aneurysms in the setting of AAA that were excluded with placement of a self-expandable covered stent. In 2 patients, the AAA had been already treated with resulting exclusion of 1 HGA, while in the remaining we treated the hypogastric aneurysm before the AAA. We used as distal landing zone the anterior division of the HGA or the SGA. We adopted a ‘‘stent-within-a-stent’’ or ‘‘telescope’’ technique to manage diameter discrepancy between proximal and distal landing zone. Results: Computed tomography angiography (CTA) at 6 and 12 months showed regular placement and patency of the stent grafts placed and absence of detectable endoleaks (EL). None of the patients developed pelvic ischemic complication at longest follow-up. Conclusions: The procedure seems to be safe and effective, with optimal primary patency of the stent grafts, freedom from type 1 and 2 endoleaks, and absence of pelvic ischemic complications in the short-term and mid-term.