Novel inferior gluteal artery access for successful type 2 endoleak embolization enabling the access site hemostasis by manual compression: A case report

Direct aneurysm or superior gluteal artery puncture is an alternative approach for internal iliac artery aneurysms after endovascular aneurysm repair. A 76-year-old man underwent endovascular aneurysm repair and bilateral internal iliac artery embolization for bilateral internal and right common iliac artery aneurysms. During the follow-up, the coils in the left internal iliac artery were recanalized, resulting in type 2 endoleak and the aneurysm enlarged. As standard antegrade or collateral access was impossible, percutaneous retrograde transgluteal inferior gluteal artery access was performed above the acetabulum with the patient in the prone position, followed by successful embolization of the internal iliac artery and aneurysm sac. Access-site hemostasis was achieved via manual compression. This access just above the acetabulum enabling stable manual compression could provide a safe option.