Unusual Access for the Treatment of Iliac Artery Aneurysm in Association with Type II Endoleak After Endovascular Repair of an Aortoiliac Aneurysm.

Internal iliac artery aneurysms (IIAAs), although rare, are associated with a significant risk of mortality, if they rupture. Endovascular approach with exclusion of the aneurysm sac from antegrade and retrograde perfusion is proved to be a feasible treatment option. However, this option is not always technically possible with a preexisting endovascular aneurysm repair (EVAR) or surgical aortoiliac reconstruction with ligation of internal iliac artery origin. We report another safe treatment option of an enlarging IIAA associated with a type II endoleak after EVAR and a standard endovascular treatment was not possible. The access to the aneurysm sac was achieved retrograde via percutaneous access to the superior gluteal artery under fluoroscopy followed by treatment with embolization of the inflow and outflow vessels.