Endovascular repair of complex aortoiliac aneurysms may necessitate distal fixation of the endograft to the external iliac artery and percutaneous embolization of the hypogastric artery for prevention of a retrograde endoleak. However, acute interruption of hypogastric perfusion can result in symptoms of pelvic ischemia. We describe a technique in which a prosthetic graft is used as an external iliac artery conduit to facilitate the passage of the endograft delivery catheter/sheath and after completion of the endovascular portion of the procedure, a surgical bypass is completed with anastomosis of the graft to the hypogastric artery.