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31 Other methods have been proposed to preserve the pelvic flow. Relocation of the iliac bifurcation with HA bypass and transposition onto the distal EIA may be used. These procedures are associated with good patency rates but increase the complexity of EVAR and may extend the duration of hospital stay.32, 33, 34, 35, 36, 37?and?38 In our series, patients with EVAR that underwent EIA to HA bypass had neither postoperative ipsilateral buttock claudication nor complications related to the procedure. However, the number of bypasses was too small and the postoperative assessment of the patency was too poor to determine if they could prevent buttock claudication efficiently. Another less invasive method uses large components or aortic cuffs to anchor the device within Selleck Temozolomide the CIA (��bell bottom�� technique).39, 40, 41?and?42 Despite concerns about longer-term durability, this technique seems reasonable for patients with CIA ectasia Veliparib research buy the use of these devices is limited to favorable anatomic conditions, which are not frequently encountered. As compared to other reports,46 the rates of postoperative sexual dysfunction were low in both groups. This study was not specifically designed to assess sexual function. We mainly asked the patients if they had retrograde ejaculation or erectile dysfunction. Other aspects of sexual function such as interest, pleasure, engagement, and orgasm were not evaluated. Some patients may have denied or simply misjudged sexual problems. In particular, we did not use questionnaires as Prinssen et al46 did in their prospective study. In addition, preoperative sexual function was not assessed accurately. Finally, due to bias inherent to the retrospective design DDR1 of this study, sexual dysfunction rates may have been underestimated. The main limitations of our study are due to the relatively small number of cases included and the lack of randomization. Bilateral AAAIBs in particular were more common in the OR, which constitute a significant selection bias as there were more patients with a complicated anatomy in the OR group. The choice of the procedure depended on the decision of the attending surgeon after discussion with the patient. Thanks to ongoing improvement of EVAR technology, graft limbs as large as 24 mm in diameter are now available. This will allow more patients with large aneurysm of the CIA extending down to the bifurcation to be treated without the need for closing the hypogastric artery. Despite these limitations, this study is the first to compare EVAR and OR for AAAIB.