Preservation or occlusion of the hypogastric artery in endovascular abdominal aortic aneurysm repair (EVAR) has long been a focus issue arising in the course of development of EVAR. Based on review of several dozen papers, the author extracts and analyzes the anatomical studies of the hypogastric artery system form a century ago to the present time, and the clinical consequences after ligation or embolization of the hyogastric artery in non-vascular operations or open surgery of the abdominal aorta and iliac artery, and after using different embolization methods of hypogastric artery during EVAR, as well as various risk factors for complications from pelvic ischemia. The final conclusion is that maintaining hypogastric artery patency in EVAR is essential. Moreover, for cases with no allowance for a patent hypogastric artery due to inevitable embolization, the measures to prevent or reduce pelvic organ ischemia, detailed operative skills and intraoperative attention points are also addressed.