In some AAAs, endografting with a bifurcated endo-prosthesis is not feasible due to anatomical restrictions, such as a narrow terminal aorta and an aneurismal, tortuous, narrow or calcified contralateral iliac artery [1, 9]. In these circumstances, aortouniiliac endograft and femoro-femoral crossover by-pass have proven efficacy to overcome the limitations and repair difficult AAAs in high-risk patients [13, 34, 40, 45, 49, 56, 61]. In other words, EVAR with aortouniiliac endoprostheses extends the morphological range of aneurysms that can be treated endoluminally and is potentially a more rapid and simple operation than bifurcated endovascular repair . This EVAR configuration was initially reported by May et al. , Parodi  and Marin et al. , with use of a balloon-expandable stent for proximal graft fixation and distal graft anastomosis to the iliac artery.
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