Transcatheter embolization of an endoleak through a vascular plug implanted in the left common iliac artery during aortouni-iliac endovascular aortic repair: A case report

A 90-year-old woman underwent aortouni-iliac endovascular aortic repair and simultaneous embolization of the left common iliac artery using a vascular plug for an impending rupture of an abdominal aortic aneurysm. The aortic aneurysm diameter gradually increased after the procedure, and an endoleak through the vascular plug in the left common iliac artery was observed by contrast-enhanced computed tomography. Using a highly penetrating microsystem to penetrate the mesh of the vascular plug, metallic coils were placed inside and around the vascular plug. Using a triple coaxial system, the proximal portion of the left common iliac artery and the endoleak cavity of the aneurysm were embolized with 20% n-butyl-2-cyanoacrylate‒Lipiodol mixture via collateral arteries. The endoleak disappeared after transcatheter embolization. To our knowledge, this is the first reported case in which transcatheter embolization with metallic coils using a highly penetrating microsystem was performed to treat an endoleak through a vascular plug following endovascular aortic repair with an aortouni-iliac device and simultaneous embolization of the contralateral common iliac artery.