Percutaneous transosseous approach for type II endoleak repair of common iliac artery aneurysm

Persistent type II endoleaks following endovascular aneurysm repair can result in continued aneurysm sac enlargement and may be difficult to treat when conventional endovascular access routes are unsuccessful. A patient with a right common iliac artery aneurysm developed a persistent type II endoleak despite multiple prior embolization attempts using standard angiographic techniques. Surveillance imaging demonstrated continued aneurysm sac enlargement to 4.8 cm. Given the failure of conventional endovascular approaches, a direct percutaneous transosseous approach was pursued. Under image guidance, access to the aneurysm sac was obtained through the right iliac bone. Following confirmation of intraluminal positioning, embolization was successfully performed using a combination of detachable coils and Obsidio conformable embolic (Boston Scientific). Completion imaging demonstrated successful occlusion of the endoleak cavity. Follow-up imaging demonstrated stabilization of the aneurysm sac without further enlargement and no evidence of recurrent endoleak. Percutaneous transosseous access represents a feasible and effective salvage technique for direct aneurysm sac embolization in patients with persistent type II endoleaks when conventional endovascular approaches have failed. This nontraditional access route expands the interventional options for managing complex endoleaks and may provide a minimally invasive alternative to surgical intervention in carefully selected patients.