Endovascular approach to the hypogastric artery

The management of hypogastric artery in patients with aorto-iliac aneurysms requires accurate planning. It is mandatory to maintain at least one hypogastric artery (HA) patent according to the more recent European Guidelines. The common iliac artery (CIA) typically serves as the distal landing zone for the iliac limb extension for aorto-iliac endografts if CIA diameter fits within the instructions for use. Alternately, it is possible to extend the endograft limb into the external iliac artery (EIA), causing hypogastric artery (HA) occlusion with potential drawbacks. The use of iliac branch devices (IBD) provided an ideal solution to preserve hypogastric flow; nevertheless, unfavourable anatomical conditions including dimension of the CIA and HA, access vessels, and tortuosity constitute technical contraindications to the use of IBD, thus excluding a wide percentage of patients. Different on- and off-label strategies are available to tailor the treatment of the hypogastric artery according to patient anatomy.