Inferior gluteal artery surgical access for embolization of large internal iliac artery aneurysm in a hostile abdomen.

INTRODUCTION: Internal iliac artery aneurysms (IIAA) are a rare entity compared with all aortoiliac aneurysms. Continuous expansion due to retrograde flow from runoff vessels can lead to rupture with devastating results. Exclusion of the aneurysm represents a challenging procedure especially if the access is limited and the patient has a history of reoperations in the pelvic region. CASE: A 78-year-old man with a history of endovascular aortic repair, coverage of internal iliac arteries and right hemicolectomy for adenocarcinoma of ascending colon presented with a rapidly expanding right IIAA (8.8 cm) due to type II endoleak. He successfully treated with coil embolization through inferior gluteal artery surgical access. CONCLUSION: Inferior gluteal artery surgical access for embolization of internal iliac aneurysms in patients with hostile abdomen or in cases where antegrade route has already been excluded, is a feasible technique.

Endovascular Stent-graft Repair of Combined Renal Artery Aneurysm and Arteriovenous Fistula.

Renal artery aneurysm with concomitant presence of arteriovenous fistula is an extremely rare entity. Few reports have been described in the literature. Nowadays, endovascular repair with covered stents or transarterial embolization with coils or glue has become the first line of treatment. We present the successful repair of a distal renal artery aneurysm combined with arteriovenous fistula with stent graft.

Aortic Arch Floating Thrombus Complicated by Distal Embolization in a Patient with Malignancy.

Free floating thrombus of aortic arch in a minimally atherosclerotic or nonaneurysmal aorta is a rare disease entity which carries a potential risk of distal embolization with catastrophic consequences. We present the case of a 52-years-old patient with ovarian cancer and aortic arch floating thrombus who initially managed with low molecular weight heparin and eventually undergone surgical thrombectomy of left external iliac and common femoral artery due to acute ischemia of left lower leg.

Endovascular Repair for a Ruptured AAA due to a Combined Type IIIb and Ia Endoleak.

We report a case of a ruptured abdominal aortic aneurysm (AAA) caused by a combined type IIIb and Ia endoleak. Also, we propose the mechanism that resulted in this combined endoleak. Specifically, a 71-year old-man, with a previous history of endovascular aneurysm repair (EVAR) for an AAA, was diagnosed with a contained rupture. CT scan depicted a type Ia endoleak and a migrated Talent endograft. A proximal aortic cuff sealed the endoleak, but intraoperative angiography revealed that a type IIIb endoleak coexisted due to fabric tear close to the Talent bifurcation. A second aortic cuff could not seal the fabric tear; so, in-lay parallel limbs were sequentially deployed as a "kissing endograft" technique inside the cuff. Simultaneous treatment of combined type IIIb and Ia endoleaks has not yet been described. Maybe the type IIIb endoleak is the primary entity causing sac enlargement, neck recontouring, proximal migration, and ultimately type Ia endoleak, which leads to huge enlargement and rupture. Placement of an aortic cuff to seal the proximal endoleak/migration and kissing endografts limbs for the fabric tear seems a safe option in such patients.