Endovascular aneurysm repair (EVAR) has become the most utilized treatment for abdominal aortic aneurysms (AAA), but the presence of common iliac dilatation or aneurysm may prevent the achievement of effective distal seal and fixation. Ideal repair in these cases should involve both effective preservation of the pelvic circulation and durable exclusion of the AAA. Unilateral or bilateral internal iliac artery (IIA) preservation with iliac branch devices (IBD) is safe, feasible and effective with technical and clinical outcomes comparable to standard EVAR. The versatility of current devices has allowed extended application to complex cases, but must be considered carefully in difficult anatomies. Pending long-term durability results and formal cost-effectiveness appraisals, IBD implantation has several advantages to anatomically eligible patients as compared with other available open or endovascular/hybrid solutions for IIA preservation during EVAR for aortoiliac aneurysms.
