“The Road Less Traveled”: Endovascular Embolization of a Type II Endoleak via Corona Mortis

Type 2 endoleaks (EL2s) are potentially life-threatening complications, defined as persistent arterial perfusion of the excluded aneurysmal sac after endovascular aneurysm repair (EVAR). Most EL2s are managed endovascularly, through embolization of the aneurysmal sac and its arterial feeders. During embolization, attention should be given to anatomical variants such as "corona mortis", an arterial anastomosis connecting external iliac (via inferior epigastric) and internal iliac (via obturator) arteries. We present the case of an 88-year-old male previously treated with EVAR for a left common iliac artery aneurysm (CIAA), complicated by EL2 originating from the ipsilateral ilio-lumbar branch of the internal iliac artery. Successful embolization of the endoleak was achieved through catheterization of the inferior epigastric artery, taking advantage of the "corona mortis" variant. This route allowed access to the sac and embolization with ethylene-vinyl-alcohol-copolymer. This approach represents a safe alternative to direct sac puncture or superior gluteal artery access in patients exhibiting this anatomical variant.