CIRSE Annual Congress

September 14-18 | Lisbon, Portugal

Patient centered - Science driven

September 14-18 | Lisbon, Portugal

Patient centered - Science driven

September 14-18 | Lisbon, Portugal

September 14-18 | Lisbon, Portugal

September 14-18 | Lisbon, Portugal

Patient centered - Science driven
ProgrammeSneak peeksPatency of the internal iliac artery

Patency of the internal iliac artery: the standard in endovascular aneurysm care in 2024

Three reasons why you cannot miss my lecture

  1. You will see that hypogastric preservation should be the goal in all your patients.
  2. I will show you that when commercially available technologies cannot be used, tube grafts and a number of double barrel techniques can be utilized. The surgical reimplantation of the hypogastric should also be considered.
  3. You will learn that technical and long-term results favour hypogastric preservation techniques.

Dr. Constantino Peña
Speaker bio 

Add this session to your calendar!

Common iliac artery aneurysm occurs in 25% of patients with infrarenal aneurysms. The presence of a common iliac artery aneurysm not only serves as a second potential cause of aortic-related mortality, but may threaten the durability of EVAR by potentially limiting the distal landing zone. Early in the experience with EVAR, the technique of “Coil and Cover” the hypogastric was the hallmark. The discussion focused on the risk of hypogastric embolization and the techniques to reduce the risk of buttock claudication, sexual dysfunction, and pelvic ischemia by promoting collateral flow performing proximal embolization and staged embolization in patients requiring possible bilateral hypogastric sacrifice. Buttock claudication and sexual dysfunction occurred in greater than 50% of patients with unilateral hypogastric coverage.

Over the last two decades, the understanding and techniques have evolved to provide several techniques to preserve hypogastric artery perfusion. Present techniques include: tube grafts (including retrograde hypogastric preservation) and bell bottom grafts into the distal common iliac artery; commercially available Iliac branch (IBE) devices; and double barrel graft techniques (parallel grafts).

How does one evaluate a patient and decide on possible treatment options?

Commercially available IBE devices are usually the first line devices. The data on the short-term technical results have now been augmented with longer term findings. The technical success rates are in the high 90% with the rate of early reinterventions at 1-4%. Understanding the anatomical recommendations for the IBE device is critical when deciding to proceed with an IBE repair. Considering the benefits and potential pitfalls of the techniques available for patients with less than ideal anatomy for an IBE device should guide the decision-making process when deciding double barrel techniques. The durability of bell bottom grafts is also important to consider. The Pelvic Registry from Italy has added much data on the durability of these repairs. The cost of these devices is also a factor that needs to be understood. The goal of creating a personalized endovascular solution for every patient and working to preserve hypogastric artery perfusion in the setting of common iliac aneurysms and proximal hypogastric aneurysms exist in 2024.

Figure 1: 79 yo male with a common iliac artery aneurysm and insufficient landing zone for IBE.
1A: demonstrates double barrel VBX (Gore) stent grafts. Ipsilateral from right external into common iliac (thin arrow) and contralateral from right common iliac into right hypogastric (thick arrow).
1B: after simultaneous deployment of double barrel stents.
1C: post angiogram demonstrating flow in both grafts


Constantino Peña

Miami Cardiac and Vascular Institute, Miami/US

Constantino S. Peña, MD is an interventional radiologist at the Miami Cardiac and Vascular Institute at Baptist Hospital in Miami Florida where he serves as the section head for interventional radiology and the medical director of vascular imaging. An educator, Dr. Peña is also a clinical associate professor of radiology at the Florida International University College of Medicine in Miami as well as a collaborative associate professor of radiology at the University of South Florida College of Medicine in Tampa, Florida.
Dr. Peña completed his residency in diagnostic radiology as well as a vascular and interventional fellowship at Massachusetts General Hospital in Boston, Mass. He has served on the SIR Annual Meeting Committee and as the Meeting Chairman for the SIR meeting. He has served as the Chair of the Cardiovascular Radiology & Intervention Council of the American Heart Association (AHA) and a board member of the IAC CT. He has served on several committees for many professional organizations, including the ABR, ACR, RSNA, and the SIR. Dr. Peña is a fellow of the SIR, AHA, and SCCT.



  1. Van der Veen D, Holewijn S, Bellosta R, et al. One Year Outcomes of an International Multicentre Prospective Cohort Study on the Gore Excluder Iliac Branch Endoprosthesis for Aorto-Iliac Aneurysms. Eur J Vasc Endovasc Surg. 2021;62(2):177-185. doi:10.1016/j.ejvs.2021.04.006
  2. Schneider DB, Milner R, Heyligers JMM, Chakfé N, Matsumura J. Outcomes of the GORE Iliac Branch Endoprosthesis in clinical trial and real-world registry settings. J Vasc Surg. 2019;69(2):367-377.e1. doi:10.1016/j.jvs.2018.05.200