Endovascular success depends heavily upon anatomical suitability for secure graft placement. Common iliac artery (CIA)
aneurysms frequently extend close to the iliac bifurcation, requiring distal fixation in the external iliac artery (EIA), in turn excluding the internal iliac artery (IIA). The preservation of circulation to at least one IIA artery is highly recommended. We report an
endovascular technique for complete preservation of the hypogastric arteries of an aorto-
iliac aneurysm extending into the iliac bifurcation and hypogastric artery. A left CIA
aneurysm involving the iliac bifurcation was excluded with a covered Fluency
stent-graft (Bard Inc., New Jersey, USA) deployed from the EIA into the IIA followed by the internal deployment of a Luminex uncovered
stent (Bard Inc.) extended into one branch of the hypograstric artery. IVUS evaluation was essential in determining precise
aneurysm and sealing zone measurements. Complete preservation of hypogastric circulation was achieved. The placement of the uncovered
stent effectively extended the sealing zones without covering either of the hypogastric distal branches and concurrently corrected the Fluency
stent kinking due to severe arterial tortuosity. In CIA
aneurysms involving the IIA, an uncovered
stent can extend the sealing zones, whilst maintaining complete preservation of pelvic circulation and offers support to the covered
stent-graft. IVUS seems necessary for precise neck evaluation.