Background: Coil embolisation of the internal iliac arteries prior to EVAR is considered standard treatment to prevent a type 2 endoleak when extending an iliac limb into the EIA. Type 2 endoleaks that arise from a non-coil-embolised internal iliac artery can be challenging to treat due to difficult access. Case presentation: We present a case of a type 2 endoleak from the internal iliac artery that was not coiled prior to EVAR. This was treated with retrograde embolisation of the internal iliac artery via direct puncture of a branch from the buttock and closure of the arteriotomy was achieved using an Angio-Seal (Terumo) device that was deployed in an off-label manner to allow visualisation. Conclusion: This is a viable technique for treating type 2 endoleaks when antegrade access to the internal iliac artery is lost due to the presence of the stent graft and the arteriotomy can be safely closed with an Angio-Seal.

The ureter is an extremely rare site for small cell neuroendocrine carcinoma. We present a case of this disease in a patient who presented without urological symptoms. The multidisciplinary team proposed nephroureterectomy (if fit) or watchful waiting as management. After discussion with the patient a decision in favour of watchful waiting was made. We report her case including a review of the literature, and emphasise that although small cell neuroendocrine carcinomas can be very aggressive, they can remain asymptomatic.