Sloughing of the scrotal skin and impotence subsequent to bilateral hypogastric artery embolization for endovascular aortoiliac aneurysm repair

Sloughing of the scrotal skin is an extremely rare event due to pelvic ischemia. We report herein one case of scrotal skin sloughing and impotence after bilateral hypogastric artery embolization for endoluminal aortoiliac aneurysm repair. Postoperative penile plethysmography demonstrated a 75% reduction in the penile brachial index, suggesting that pelvic ischemia is the main culprit for this complication. The devastating morbidity in our patient underscores the importance of maintaining pelvic collateral circulation when planning for endovascular aortoiliac aneurysm repair.