LAUSR

BACKGROUND Internal iliac artery aneurysms (IIAAs) are rare, comprising 0.3% of all aortoiliac aneurysms. Endovascular management is associated with lower morbidity and mortality than open repair. We present a 91-year-old female with a rapidly expanding 8.2-cm IIAA who previously underwent incomplete endovascular treatment, using endovascular aneurysm repair, to exclude the right internal iliac artery (IIA). Transarterial access to the IIAA was not possible secondary to the iliac limb of the endograft over the origin of the IIA. We recommended that the patient undergo embolization and coiling of the IIAA via a direct percutaneous transgluteal approach. METHODS With the patient in a prone position, under fluoroscopic guidance, a 10-cm long, 18-gauge needle was placed through the gluteus muscle into the right IIAA. Needle location was confirmed by angiography and a 6-French sheath was advanced into the aneurysm. Selective catheterization of the native aorta was accomplished around the occluded limb of the previously placed endograft. Aortography confirmed robust filling of 2 large lumbar arteries with brisk runoff through branches of the IIA. Coil embolization was used to treat both the lumbar arteries causing aortic endoleak, as well as the outflow branches of the IIAA. RESULTS Completion angiography revealed static flow in the aorta and aneurysm, with minimal flow through the inflow and outflow tracts. At a 1-month follow-up appointment, repeat computed tomography angiography revealed resolution of the endoleak and no blood flow within the aneurysm. There have only been a few case reports utilizing alternative access to an IIAA. Although computed tomography and ultrasound-guided techniques have been described in the literature, a percutaneous, fluoroscopy-guided, transgluteal approach to access the IIAA is a new and unique approach. CONCLUSIONS In patients who are not candidates for open or standard endovascular repair with a large, inaccessible IIAA, a transgluteal approach to directly access the aneurysm sac may offer a less invasive and successful management strategy.