Novel Treatment of an Enlarging Internal Iliac Artery Aneurysm in Association with a Type 2 Endoleak via Percutaneous Embolisation of the Superior Gluteal Artery through a Posterior Approach
Internal iliac artery (IIA) aneurysms, while rare, carry a significant risk of mortality if they rupture. Endovascular intervention is now the preferred method of treatment for IIAs; however, due to technical considerations, this is not always feasible. We report a case of a patient who developed an enlarging IIA aneurysm in association with a type 2 endoleak supplied by multiple feeding arteries where conventional endovascular treatment was not possible. A novel method of effectively treating the IIA aneurysm with a posterior approach via image-guided puncture of the superior gluteal artery was employed. Five arteries supplying the superior gluteal from the contralateral internal iliac artery were selectively catheterised and coiled before the aneurysmal sac was embolised. The patient made an uneventful recovery, and follow-up imaging demonstrated resolution of the endoleak and decompression of the aneurysmal sac. This case demonstrates that the posterior approach is a safe and viable method of treating internal iliac artery aneurysm when traditional endovascular approaches are technically possible. 1. Introduction Internal iliac artery (IIA) aneurysms, while rare, carry a significant risk of mortality if they rupture. Endovascular intervention is now the preferred method of treatment for IIAs; however, due to technical considerations, this is not always feasible. In such cases, percutaneous direct puncture of the aneurysmal sac under image guidance, followed by embolisation of the sac and feeding arteries, has been shown to be an effective method of management. A variety of approaches to access the IIA aneurysmal sac have been described in the literature, and different methods of embolization have been employed to exclude the aneurysm from the circulation. We report a case where a patient developed an enlarging IIA aneurysm in association with a type 2 endoleak supplied by multiple feeding arteries where conventional endovascular treatment was not possible. A novel method of effectively treating the IIA aneurysm via image-guided puncture of the superior gluteal artery and embolisation of the feeding arteries and aneurysmal sac is described. 2. Case Report An 82-year-old male presented with a large right IIA aneurysm diagnosed during routine surveillance on a long background history of complicated aortoiliac endovascular intervention. His comorbidities included chronic renal failure, hypertension, and hyperlipidaemia. He had undergone an endovascular AAA repair 9 years previously for treatment of a 5？cm infrarenal abdominal aortic aneurysm. This
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