Ruptured aneurysms of the internal iliac artery (IIA) are rare and challenging to treat surgically. Due to their anatomic location they are difficult to operate on and perioperative morbidity is high. An endovascular approach can be helpful. We recently treated a patient with a ruptured IIA aneurysm in the interventional radiology suite with embolization of the side-branch of the IIA and placement of a covered stent in the ipsilateral common and external iliac arteries. A suitable stent-graft was not available initially and had to be brought in from elsewhere. An angioplasty balloon was temporarily placed across the ostium of the IIA to obtain hemostasis. Two hours later, the procedure was finished by placing the stent-graft.The purpose of treatment of an aneurysm is to exclude it from the circulation and to restore distal vascularization. In patients with a ruptured aneurysm, emergency treatment is warranted. Two methods of treatment are currently available: open surgery and endovascular aneurysm repair (EVAR). Due to their location internal iliac artery (IIA) aneurysms are not directly accessible for stent-graft placement. Thus, endovascular treatment consists of excluding the vessel from the circulation by coiling the side-branches of the IIA and placing a covered stent in the ipsilateral common iliac artery (CIA) and external iliac artery (EIA) covering the origin of the IIA. In this report we present a patient with acute rupture of an IIA aneurysm that was successfully treated with endovascular techniques in the interventional radiology suite. Case ReportA 72-year-old obese man was admitted to our hospital with a 1 week history of abdominal pain, located mainly in the right lower quadrant. On physical examination there was abdominal tenderness, mainly on the right side. Blood pressure was 145/92 mmHg; heart rate was 120 beats/min. Blood analysis showed some elevated liver enzymes and a hemoglobin level of 9.0 mmol/l. During investigation of the patient, his condition deteriorated, his heart rate rose to above 120 beats/min, and systolic blood pressure fell below 100 mmHg.Abdominal sonography showed free intra-abdominal fluid and a large aneurysm in the right lower abdomen. At sonographic-guided puncture blood was aspirated. Subsequently CT-angiography (CTA) was performed which showed an aneurysm of the right IIA with a size of 7.5 cm and a discontinuous irregular ring of calcifications in the vessel wall (Fig. 1). Perivascular stranding and intraabdominal fluid indicated rupture. Only one of the descending branches of the right IIA seemed patent. In addition there was an aneurysm of the left CIA with a diameter of 3.0 cm, which was not ruptured.Two treatment options were considered: open surgery or endovascular treatment. The development of hypovolemic shock and the patient's morbid obesity, combined with the known difficulties of treating a large IIA aneurysm by open surgery, made us decide to attempt endovascular treatment [1,2]. Because of continuing leakage of the aneurysm hemostasis had to be ...

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Purpose: The aim of this study was to assess the initial experience, technical success, and clinical benefit of AneuFix (TripleMed, Geleen, the Netherlands), a novel biocompatible and non-inflammatory elastomer that is directly injected into the aneurysm sac by a translumbar puncture in patients with a type II endoleak and a growing aneurysm. Materials and Methods: A multicenter, prospective, pivotal study was conducted (ClinicalTrials.gov:NCT02487290). Patients with a type II endoleak and aneurysm growth (>5 mm) were included. Patients with a patent inferior mesenteric artery connected to the endoleak were excluded for initial safety reasons. The endoleak cavity was translumbar punctured with cone-beam computed tomography (CT) and software guidance. Angiography of the endoleak was performed, all lumbar arteries connected to the endoleak were visualized, and AneuFix elastomer was injected into the endoleak cavity and short segment of the lumbar arteries. The primary endpoint was technical success, defined as successful filling of the endoleak cavity with computed tomography angiography (CTA) assessment within 24 hours. Secondary endpoints were clinical success defined as the absence of abdominal aortic aneurysm (AAA) growth at 6 months on CTA, serious adverse events, re-interventions, and neurological abnormalities. Computed tomography angiography follow-up was performed at 1 day and at 3, 6, and 12 months. This analysis reports the initial experience of the first 10 patients treated with AneuFix. Results: Seven men and 3 women with a median age of 78 years (interquartile range (IQR), 74-84) were treated. Median aneurysm growth after endovascular aneurysm repair (EVAR) was 19 mm (IQR, 8–23 mm). Technical success was 100%; it was possible to puncture the endoleak cavity of all treated patients and to inject AneuFix. Clinical success at 6 months was 90%. One patient showed 5 mm growth with persisting endoleak, probably due to insufficient endoleak filling. No serious adverse events related to the procedure or AneuFix material were reported. No neurological disorders were reported. Conclusion: The first results of type II endoleak treatment with AneuFix injectable elastomer in a small number of patients with a growing aneurysm show that it is technically feasible, safe, and clinically effective at 6 months. Clinical Impact Effective and durable embolization of type II endoleaks causing abdominal aortic aneurysms (AAA) growth after EVAR is challenging. A novel injectable elastic polymer (elastomer) was developed, specifically designed to treat type II endoleaks (AneuFix, TripleMed, Geleen, the Netherlands). Embolization of the type II endoleak was performed by translumbar puncture. The viscosity changes from paste-like during injection, into an elastic implant after curing. The initial experience of this multicentre prospective pivotal trial demonstrated that the procedure is feasible and safe with a technical success of 100%. Absence of AAA growth was observed in 9 out of 10 treated patients at 6 months.