Branch Endograft Research Articles

Single-center Experience With Complex Abdominal and Thoracoabdominal Aortic Aneurysm Treated by Open or Endovascular Repair Using Fenestrated and Branch Endografts

Single-center Experience With Complex Abdominal and Thoracoabdominal Aortic Aneurysm Treated by Open or Endovascular Repair Using Fenestrated and Branch Endografts

Early Outcomes of a Novel Off the Shelf Preloaded Inner Branch Endograft for the Treatment of Complex Aortic Pathologies in the ItaliaN Branched Registry of E-nside EnDograft (INBREED)

Early Outcomes of a Novel Off the Shelf Preloaded Inner Branch Endograft for the Treatment of Complex Aortic Pathologies in the ItaliaN Branched Registry of E-nside EnDograft (INBREED)

Gore TAG thoracic branch endograft for treatment of a subacute type B aortic dissection complicated by rupture

An 80-year-old man presented with a subacute zone 3-5 type B aortic dissection complicated by rupture and visceral and lower extremity malperfusion. He underwent emergent zone 2 repair with a Gore TAG thoracic branch endograft with inclusion of the left subclavian artery for a dominant left vertebral artery. The patient's postoperative course was uncomplicated. Type B aortic dissections can be anatomically complex, and rupture is a rare complication in the subacute phase. We report the novel use of a Gore TAG thoracic branch endograft for the management of type B aortic dissection complicated by rupture and demonstrate its feasibility for patients with type B aortic dissection complicated by rupture.

Inner Branch Endografts for the Treatment of Complex Abdominal Aortic Aneurysms, Off-the-Shelf and Custom-Made Presentation

Inner Branch Endografts for the Treatment of Complex Abdominal Aortic Aneurysms, Off-the-Shelf and Custom-Made Presentation

Editor's Choice – Early Outcomes of a Novel Off the Shelf Preloaded Inner Branch Endograft for the Treatment of Complex Aortic Pathologies in the ItaliaN Branched Registry of E-nside EnDograft (INBREED)

The aim of this study was to investigate the early outcomes of a novel off the shelf pre-loaded inner branched thoraco-abdominal endograft (E-nside) in the treatment of aortic pathologies. Data from a physician initiated national multicentre registry on patients treated with the E-nside endograft, were prospectively collected and analysed. Pre-operative clinical and anatomical characteristics, procedural data, and early outcomes (90 days) were recorded in a dedicated electronic data capture system. The primary endpoint was technical success. Secondary endpoints were early mortality (90 days), procedural metrics, target vessel patency, endoleak rate, and major adverse events (MAEs) at 90 days. In total, 116 patients from 31 Italian centres were included. Mean ± standard deviation (SD) patient age was 73 ± 8 years and 76 (65.5%) were male. Aortic pathologies included degenerative aneurysm in 98 (84.5%), post-dissection aneurysm in five (4.3%), pseudoaneurysm in six (5.2%), penetrating aortic ulcer or intramural haematoma in four (3.4%), and subacute dissection in three (2.6%). Mean ± SD aneurysm diameter was 66 ± 17 mm; aneurysm extent was Crawford I - III in 55 (50.4%), IV in 21 (19.2%), pararenal in 29 (26.7%), and juxtarenal in four (3.7%). The procedure setting was urgent in 25 (21.5%) patients. Median procedural time was 240 minutes (interquartile range [IQR] 195, 303), with a median contrast volume of 175 mL (IQR 120, 235). The endograft's technical success rate was 98.2% and the 90 day mortality rate was 5.2% (n= 6; 2.1% for elective repair and 16% for urgent repair). The 90-days cumulative MAE rate was 24.1% (n= 28). At 90 days, there were 10 (2.3%) target vessel related events (nine occlusions and one type IC endoleak) and one type 1A endoleak requiring re-intervention. In this real life, non-sponsored registry, the E-nside endograft was used for the treatment of a broad spectrum of aortic pathologies, including urgent cases and different anatomies. The results showed excellent technical implantation safety and efficacy, as well as early outcomes. Longer term follow up is needed to better define the clinical role of this novel endograft.

Early Outcomes of a Novel Off-the-shelf Preloaded Inner Branch Endograft for the Treatment of Complex Aortic Pathologies in the ItaliaN Branched Registry of E-nside EnDograft (INBREED)

Early Outcomes of a Novel Off-the-shelf Preloaded Inner Branch Endograft for the Treatment of Complex Aortic Pathologies in the ItaliaN Branched Registry of E-nside EnDograft (INBREED)

Theoretical Feasibility of Using Arch Branched Endograft Devices for Repair of Post Type A Aortic Dissection in Patients With Prior Ascending Aortic Replacement

Purpose: Ascending aortic replacement is a common emergency procedure for treating acute type A aortic dissection. Secondary open or endovascular interventions for residual arch pathologies is difficult because of adhesions, short prosthetic grafts, and distorted anatomies. Aortic arch branched stent grafts have emerged as a potential solution for these patients if they have suitable anatomical conditions. This study aimed to evaluate the theoretical anatomical and technical feasibility of 2 currently used aortic arch branch endografts in patients who had prior replacement of the ascending aorta. Materials and Methods: All patients who had a prosthetic ascending aortic or hemiarch replacement for acute type A dissection in a single institution between January 2013 and December 2018 were included. Contrast computed tomography images on the most recent follow-up were analyzed on a 3-dimensional workstation. Morphological parameters were measured individually for the ascending aorta, aortic arch, supra-aortic branches, and access iliac arteries. The computed tomography scan of each patient was individually evaluated for anatomical suitability for the arch branched and double-branch devices according to set selection criteria. Results: Computed tomography images of 56 patients (median age of 57 years, 45 males) were reviewed. Based on our evaluation, 26 patients (46.4%) were good candidates for an endovascular arch branched device. It would be feasible for 13 patients (23.2%), but prudent preoperative planning was required due to complicated anatomy. The other 17 patients (30.4%) were unsuitable because they met at least 1 exclusion criterion. Short prosthetic grafts, extreme graft angulations, and extensive dissections in the supra-aortic branches were the main reasons for exclusion. Conclusion: Endovascular repair using arch branched endografts is feasible in patients with prior ascending aortic arch or hemiarch replacement for acute type A aortic dissection. The most common anatomical conditions that may influence the feasibility of the arch branched endograft procedure include insufficient proximal seal length, severe angulation of the graft, and extensive aortic dissection within the supra-aortic vessels.

Evaluation of the Gore TAG thoracic branch endoprosthesis in the treatment of proximal descending thoracic aortic aneurysms

BackgroundThoracic endovascular aortic repair has radically transformed the treatment of descending thoracic aortic aneurysms. However, when aneurysms involve the aortic arch in the region of the left subclavian artery, branch vessel preservation must be considered. Branched aortic endografts have provided a new option to maintain branch patency. MethodsSix investigative sites enrolled 31 patients in a nonrandomized, prospective investigational device exemption feasibility trial of a single branched aortic endograft for the management of aneurysms that include the distal aortic arch. The Gore TAG thoracic branch endoprosthesis (W. L. Gore & Associates, Inc, Flagstaff, Ariz), an investigational device, allows for graft placement proximal to the left subclavian artery and incorporates a single side branch for left subclavian perfusion. ResultsAll 31 patients (100%) had undergone successful implantation of the investigational device in landing zone 2. Men slightly outnumbered women (51.6%). Their average age was 74.1 ± 10.4 years. The aneurysm morphology was fusiform in 12 and saccular in 19 patients, with a mean maximum aortic diameter of 54.8 ± 10.9 mm. The mean follow-up period for the cohort was 25.2 ± 11.1 months. We have reported the patient outcomes at 1 month and 1 year. At 1 month, the side branch patency was 100% and the freedom from core laboratory-reported device-related endoleak (types I and III) was 96.7%, without 30-day death or permanent paraplegia. One patient experienced a procedure-related stroke. Through 1 year, five patients had died; none of the deaths were related to the device or procedure (clinical endpoint committee adjudicated). One thoracic reintervention was required. No conversions were required, and no aneurysm growth (core laboratory) was reported. One case of the loss of side branch patency was diagnosed in the left subclavian artery in an asymptomatic individual from computed tomography at 6 months, with no reported subsequent adverse events due to loss of patency. Endoleaks were reported by the core laboratory in five patients at 12 months (two, type II; and three, indeterminate). ConclusionsThe present investigational device exemption feasibility study has reported the preliminary results of the use of a single side branch endograft to treat patients with proximal descending thoracic aortic aneurysms.

Two-year evaluation of fenestrated and parallel branch endografts for the treatment of juxtarenal, suprarenal, and thoracoabdominal aneurysms at a single institution

ObjectiveDespite numerous recent pivotal and small-scale trials, real-world endovascular management of juxtarenal aneurysms (JRA), suprarenal aneurysms (SRA), and thoracoabdominal aortic aneurysms (TAAA) remains challenging without consensus best practices. This study evaluated the mortality, graft patency, renal function, complication, and reintervention rates for fenestrated and parallel endografts in complex aortic aneurysms repairs. MethodsThis retrospective review of consecutive included patients with JRA, SRA, or TAAA who underwent complex endovascular repair from August 2014 to March 2017 at one high-volume institution. Treatment modality was a single surgeon decision based on patients anatomy and the urgency of the repair. Patient demographics, hospital course, and follow-up visits inclusive of imaging were analyzed. Ruptured aneurysms were excluded. Survival rates and outcomes were determined using the Kaplan-Meier method with log-rank tests. ResultsSeventy complex endovascular aortic repairs were performed; 38 patients with TAAA were treated with snorkel/sandwich parallel endografts (21 celiac, 28 superior mesenteric arteries, 58 renal arteries) and 32 patients with JRA/SRA were treated by fenestrated endovascular aneurysm repair (FEVAR) with 94 total fenestrations (2 celiac, 30 SMA, 62 renal). The mean patient age was 74.8 ± 10.0 years. Sixty percent were male, and the mean aortic aneurysm diameter was 6.0 ± 1.4 cm. Perioperative mortality was 3.1% (1/32) for FEVAR compared with 2.6% (1/38) for parallel endografts (P = .9). All-cause reintervention rates were 15.6% in FEVAR (5/32) vs 23.6% with parallel endografts (9/38; P = .4). Branch reintervention rates per each branch endograft were 4.3% for FEVAR (4/94; 2 renal stent occlusions, 1 colonic ischemia without technical issue found on reintervention, 1 perinephric hematoma) vs 3.7% for parallel endografts (4/107; 2 renal and 1 celiac stent thromboses, and 1 renal stent kink; P = .41). The endograft branch thrombosis rate was 2.1% in FEVAR (2/94) vs 2.7% in parallel endografts (3/109; P = .77). Reinterventions owing to endoleaks were performed in five patients (2 type I, 2 type III, and 1 gutter endoleak; 13.1%) with parallel grafts vs no endoleak reinterventions in FEVAR. The overall survival and freedom from aneurysm-related mortality at 24 months was 78% and 96.9% in FEVAR vs 73% and 93.4% for parallel endografts (P = .8 and P = .6). The median follow-up was 12 months (range, 1-32 months). ConclusionsParallel and fenestrated endografts have acceptable and comparable mortality and patency rates in endovascular treatment of JRA, SRA, and TAAA. This study reaffirms that parallel endografts are a safe and viable alternative to fenestrated devices for complex aortic aneurysmal disease despite often treating more urgent patients and more complicated anatomy unable to be treated with FEVAR.

Arch branch endografts for arch aneurysms associated with bovine anomaly

Bovine aortic arch is known to be associated with an increased rate of aortic arch expansion. The most frequently observed human variant of bovine aortic arch is a common origin of the innominate trunk and left common carotid artery. This is a report of two patients who had successful custom-made arch branch endograft treatment for an arch aneurysm associated with bovine arch anomaly. Modular endovascular repair of aortic arch aneurysms using an inner-branched device adds to the armamentarium of treatment options, and is a minimally invasive management modality without the need for sternotomy or intraoperative extracorporeal bypass.

Simplifying aortic arch surgery: open zone 2 arch with single branched thoracic endovascular aortic repair completion.

Distal aortic complications from acute DeBakey I dissection repair are an important source of late morbidity and mortality. We present an early experience of using a novel single-branched thoracic aortic endograft in conjunction with open techniques to treat acute DeBakey I aortic dissection. The patients in this series include five hyperacute dissections managed with a combined zone 2 partial arch replacement and placement of a zone 2 single subclavian branch endograft. There were no perioperative mortalities, strokes, or spinal cord ischemia in any patients at either stage of the procedure. At follow-up imaging, no patients had anterograde flow into the false lumen. All patients experienced false lumen thrombosis in the stented portion of the aorta. This combination of open repair techniques and the use of a novel branched endograft resulted in excellent early outcomes in this pioneer series. Further investigation of these techniques in a prospective fashion is warranted.

Complex endovascular repair of postdissection arch and thoracoabdominal aneurysms

ObjectiveWe report our experience of the treatment of postdissection arch aneurysms and thoracoabdominal aortic aneurysms (TAAAs) by endovascular repair using fenestrated and branched endografts. MethodsThis study includes all patients presenting with chronic postdissection aneurysms >55 mm in diameter deemed unfit for open surgery and treated by complex endografting between October 2011 and April 2017. Where appropriate, staged management strategies including left subclavian artery revascularization, thoracic endografting, dissection flap fenestration, and tear enlargement were performed before the complex endovascular repair. Outcome data were collected prospectively, specifically including technical success, endoleaks, target vessel patency, aneurysm diameter, adverse events, reinterventions, and mortality. ResultsWe treated 40 patients with a median age of 63 years (55-71 years). In total, 43 procedures were performed: 19 arch repairs using inner branch endografts (one to three branches) and 24 TAAA repairs using fenestrated or branched endografts. Three patients were treated using both arch and TAAA repair. The median time between initial presentation with acute dissection and the first complex aortic repair was 5 years (3.0-10.0 years). Staged procedures were performed in 33 of 40 patients (82.5%). The technical success rate was 93%, the median procedure length was 240 minutes (170-285 minutes), and the median dose-area product was 80 Gy · cm2 (54.3-138.4 Gy · cm2). The 30-day and in-hospital mortality rates were 2.3% (1/43) and 4.7% (2/43), respectively. The spinal cord ischemia rate was 7% and occurred only after TAAA repair. One stroke with partial recovery and one transient ischemic attack were observed (4.7%) after arch repair. Six early reinterventions (14%) were performed: three for access complications, two to treat acute hemorrhage, and one to treat a type II endoleak. Median follow-up was 25.5 months (11-42.25 months). The 1- and 5-year survival rates were 90% and 76.4%, respectively. Late reinterventions were required in eight patients, two in the arch group (to treat endoleaks at 3 and 33 months) and six in the TAAA group (2 iliac and 1 bifurcated endograft extensions, 2 additional renal stents, 1 inferior mesenteric artery embolization). Aneurysm diameter was stable (72%) or shrank (23%) during follow-up. Enlargement was shown in two patients with endoleaks. ConclusionsComplex endovascular repair of postdissection aneurysms is a safe procedure in patients deemed unfit for open surgery. Our experience suggests that close follow-up is mandatory as secondary procedures are frequently required to completely exclude the false lumen.

Two-Year Evaluation of Fenestrated and Parallel Branch Endografts for the Treatment of Juxtrarenal, Suprarenal, and Thoracoabdominal Aneurysms at a Single Institution

Two-Year Evaluation of Fenestrated and Parallel Branch Endografts for the Treatment of Juxtrarenal, Suprarenal, and Thoracoabdominal Aneurysms at a Single Institution

IP089. Options for Preservation of Pelvic Circulation During Endovascular Aortic Aneurysm Repair

Maintenance of pelvic circulation reduces risks of ischemic colitis, buttock claudication, erectile dysfunction, and spinal cord ischemia during the treatment of aortoiliac aneurysmal disease. We evaluated the use of four techniques for preservation of flow to hypogastric arteries. All patients undergoing endovascular aneurysm repair requiring extension into the external iliac artery (and therefore management of the hypogastric artery) at a single institution were reviewed from 2006 to 2016. Choice of preservation vs embolization and preservation technique was at surgeon discretion. Four techniques were used in the series: external-to-internal iliac artery endovascular bypass (EIA-IIA), iliac branch endograft (IBD), kissing iliac stents extended from the gate of a bifurcated endograft (parallel grafts), and double bifurcated main-body graft use. Surveillance included duplex ultrasound imaging 1 month and 6 months postoperatively and annually thereafter for patients who required cross-femoral bypass (with the EIA-IIA bypass). For the remainder of patients, surveillance computed tomography scan (with selective contrast usage) was done 1 month postoperatively and annually thereafter. Thirty-two patients (mean age, 70 years; 97% male) were treated, preserving 36 hypogastric arteries. Most were treated for primary disease (n = 20), and the remainder was secondary interventions following open repair (n = 4) or endovascular repair (n = 8). Thirty patients had bilateral common iliac aneurysms, one had bilateral hypogastric aneurysms, and the remaining 18 had unilateral common iliac aneurysms. There was no preference for laterality (right, n = 20; left, n = 16). Proximal extension requiring snorkel/fenestration was present in seven patients. Seventeen aneurysms were treated with EIA-IIA bypass, 2 by IBD, 4 with double-bifurcated endografts, and 13 with parallel grafts. Technical success was 100%, with mean operative time 182 minutes and 71 mL contrast usage (range, 30-275 mL). Median length of stay was 3 days (range, 1-13 days). Over a mean follow-up of 22 months, there were no aortic-related mortalities, one EIA-IIA bypass occlusion (asymptomatic), and one reintervention (for type II endoleak). There were no additional endoleaks and no sac growth. The incidence of bowel ischemia, buttock claudication, and paralysis was zero in the series. While it is not yet clear which patients warrant preservation vs embolization, multiple techniques exist for preservation of pelvic circulation during endovascular repair. All four techniques presented appear to offer acceptable success and patency rates, and the optimal technique for each patient is largely a factor of preoperative selection based on anatomy and surgeon experience.

Current results of endovascular repair of thoraco-abdominal aneurysms†

Fenestrated and branch endografts represent a totally endovascular solution for high-risk patients with atherosclerotic thoraco-abdominal aortic aneurysms (TAAAs). This study reports the early outcome of endovascular TAAA repair. Interrogation of a prospective database of consecutive patients who underwent endovascular repair (EVAR) for TAAA between June 2007 and October 2012. Sixty-two high-risk patients (55 men; median age 72, range 54-84 years) underwent fenestrated (n = 39) or branch (n = 23) EVAR for non-ruptured TAAA [extent I-III (n = 26) and IV (n = 36)]. Twenty patients had undergone 22 previous aortic procedures. A total of 221 target vessels (coeliac 50, superior mesenteric 61, renal 106, left subclavian 1 and hypogastric 3) were preserved with scallops (n = 17), fenestrations (n = 140) or branches (n = 62) and 201 of these vessels were stent-grafted (coeliac 34, superior mesenteric 58, renal 105, left subclavian 1 and hypogastric 3). The 30-day mortality was 1.6% (n = 1) and one further patient died on postoperative day 62 from respiratory complications. Spinal cord injury (SCI) developed in 5 (8%) patients (3 women and 2 men). Two patients required temporary renal replacement therapy and a further two commenced planned postoperative dialysis. In high-risk patients with TAAA, fenestrated and branch EVAR is associated with low early mortality and requirement for renal support, but the risk of SCI is not insignificant despite the use of cerebrospinal fluid drainage and blood pressure manipulation. Our current practice is to stage the repair of extent I-III aneurysms and this has significantly reduced the incidence of SCI.

Endovascular Treatment of Aorto-iliac Aneurysms: Four-year Results of Iliac Branch Endograft

The aim of this report was to analyse early and mid-term outcomes of endovascular treatment (endovascular aneurysm repair, EVAR) for aorto-iliac aneurysms with the use of an iliac branch device (IBD). A total of 85 EVAR procedures with IBD were electively carried out in 81 patients between September 2007 and August 2012. Technical success was obtained in 98.7% of the cases. The mean follow-up duration was 20.4 months (SD ± 15.4). There was one IBD occlusion (1.2%). Estimated 48 months' survival, freedom from re-intervention and branch occlusion were 76.7%, 88.3% and 98%, respectively. EVAR for aorto-iliac aneurysms using IBD is an effective procedure with low complication and re-intervention rates at mid-term follow-up.

Nationwide Trends and Regional/Hospital Variations in Open Versus Endovascular Repair of Thoracoabdominal Aortic Aneurysms

Conclusions: Use of thoracic endovascular aortic repair (TEVAR) for thoracoabdominal aortic aneurysm (TAAA) repair has increased significantly. Rates of open thoracoabdominal repair have, however, remained relatively stable. Patients otherwise not surgical candidates, or who did not otherwise meet traditional surgical indications for open thoracoabdominal repair, are those most commonly treated with TEVAR for thoracoabdominal aneurysm repair. This occurs most commonly in regions or hospitals where open thoracoabdominal repair is less often performed. Summary: TAAA is an infrequent but highly complex disease with high perioperative morbidity and mortality rates. Perioperative mortality rates for TAAA, even in experienced centers, range from 4% to 16%. Given the morbidity and mortality associated with open TAAA repair, potentially less morbid procedures using TEVAR with adjunctive surgical visceral vessel debranching (hybrid approach) or TEVAR with specialized branch endografts have emerged as alternatives to open TAAA repair. The authors sought to determine regional and hospital variation in use of TEVAR for treatment of TAAA using the Nationwide Inpatient Sample Database from 2002 to 2005. They attempted to identify all patients with a diagnosis of TAAA who were treated with a TEVAR-based technique or standard open thoracoabdominal aortic repair. Procedures were compared between years, across regions and between hospitals of various sizes. The rate of open thoracoabdominal aortic repair remained relatively stable (range, 7.5/100 patients in 2005 to 10.1/100 patients in 2008; P = .26), whereas the rate of TEVAR-assisted repairs increased dramatically (range, 1.4/100 patients in 2005 to 6.3/100 patients in 2008; P < .0001). In 2008, 29% of all TEVAR-based procedures and 11% of all open thoracoabdominal aneurysm repairs were performed in western regions of the United States (P = .03). Smaller hospitals performed 13% of all TEVAR-based thoracoabdominal procedures and 3% of all open thoracoabdominal aneurysm repairs (P < .0001). Comment: I am not sure anyone should be surprised by the fact that there may be regional variation in the performance of surgical procedures. The bigger question is not whether regional variation of surgical procedures exists but whether regionalization of complex procedures should eventually be mandated. If regionalization is mandated, how far should patients be required to travel for their care and how much additional expense should their family entail to be with their family member during the course of the procedure? The authors correctly emphasize concerns for patient safety, but personal, logistic, and economic issues also considerably muddy the waters.

Aortic type B dissection with acute expansion of iliac artery aneurysm in previous endovascular repair with iliac branched graft

We report the case of a patient previously treated with an iliac branch endograft for isolated iliac artery aneurysm who developed, more than 2 years later, a type B aortic dissection resulting in the acute expansion of the previously excluded iliac aneurysm. Successful endovascular salvage is described.

Endovascular treatment of iliac aneurysm: Concurrent comparison of side branch endograft versus hypogastric exclusion

To analyze early and mid-term outcome of endovascular treatment in patients with iliac aneurysms, comparing the results of hypogastric revascularization by branch endografting with those of hypogastric occlusion. Consecutive patients with iliac aneurysms receiving side branch endograft (Group I) were compared with those receiving endograft with hypogastric exclusion (Group II) during the interval from January 2000 to May 2008. Procedural details and outcomes were prospectively collected and were analyzed at one year to avoid mismatch in follow-up length. A total of 74 patients (mean age, 75.8 years, 95% males) were treated: 32 in Group I and 42 in Group II. No differences in baseline risk factors and aneurysm diameter (40.2 +/- 7.9 mm in Group I vs. 38.4 +/- 10.8 in Group II) were found. Concurrent treatment of aortic aneurysm was performed in 25/32 (78%) of Group I and 36/42 (86%) of Group II. Fluoro time was 48 minutes (interquartile range [IQR] 31-57) in Group I vs. 31 minutes (IQR 23-38) in Group II (P = .04). The amount of contrast was similar in both Groups: 184 ml (IQR 155-210) in Group I vs. 183 ml (IQR 155-200) in Group II. No intestinal ischemia or deaths occurred. There were no significant differences in failures of hypogastric side branch deployment (2/32) compared with hypogastric coiling (3/42). Limb occlusions all occurring in the external iliac artery side were 2/32 in Group I vs. 3/42 in Group II. Reintervention rates were similar (5/32 vs. 4/42) at one year. Shrinkage of 5 mm or more was detected in 7/23 (30%) of Group I and in 13/37 (34%) of Group II. Iliac endoleak was present in eight patients (19%) in Group II and in one patient in Group I (4%) (P = .1). Similarly, buttock claudication or impotence were more frequent after hypogastric exclusion, recorded in eight patients in Group II and in one patient in Group I (P = .1). Endovascular treatment of iliac aneurysm with hypogastric revascularization through side branched endografts is feasible and safe in the mid-term. When compared with hypogastric embolization, this option leads to similar technical success and reintervention rates. Endoleak and buttock claudication occur frequently in patients with iliac aneurysm treated with hypogastric exclusion, while are uncommon in those with hypogastric revascularization. Side branch endografting for iliac aneurysm may be considered a primary choice in younger, active patients with suitable anatomy, but larger studies and longer postoperative observation periods are needed.