LAUSR

Bilateral isolated hypogastric aneurysm (HA) is a rare type of abdominal aneurysm. Endovascular repair has become predominant compared with surgical repair because of its minimal invasiveness. However, type-II endoleak after procedure may lead to continuous enlargement of HA and rupture. Herein, we report a rare case involving a very large HA induced by type-II endoleak after endovascular repair. A 68-year-old male patient underwent endovascular repair of bilateral isolated HAs 4 years ago. Stent grafts were used to block the orifices of bilateral HAs, and main distal outflows were embolized with coils. In the absence of a 4-year follow-up, he returned to the clinic with symptoms of lower abdominal pain and frequent urination. Computer tomography angiography revealed a giant left HA with a maximum diameter of 18 cm combined with the enlargement of the left common iliac artery (CIA) induced by type-II endoleak. The right isolated HA decreased from 5.5 cm to 3 cm. Angiography was performed, and multiple arteries from the middle sacral and external iliac arteries were detected as the sources of type-II endoleak. Considering the compression effect, surgical repair of the left giant HA was performed. Thrombus was removed from the giant aneurysm, and the distal outflows of HA were sutured. As the left CIA was enlarged, a prosthetic graft was interposed through the inner side of the previous cover stent to revascularize the external iliac artery. The patient had an uneventful postoperative clinical course and was discharged from the hospital 7 days after operation. Treatments of HA induced by type-II endoleak require regular patient follow-ups to monitor specific conditions, particularly the embolization of distal outflows. Surgical repair remains the first choice for HA with compression symptoms.