Iliac Limb Perigraft Access with Robotic Catheter Assistance for Type 2 Endoleak Embolization

Retrograde perigraft access to the aneurysmal sac for type 2 endoleak embolization is a relevant alternative to standard transarterial and translumbar approaches. Entering the space between the graft and the iliac artery requires support and pushability, and might be challenging with standard endovascular catheters. We describe the case of a 78-year-old woman with an enlarging aneurysm due to type 2 endoleak, 3 years after EVAR. Despite multiple attempts at manual catheterization, we were unable to engage the space between the iliac wall and the stent graft. The assistance of a robotic catheter allowed for precise positioning of the wire and catheter, maximizing pushability. This permitted fast wire access to the perigraft space and facilitated catheter progress to the sac expeditiously. Endovascular robotic catheter assistance allows optimal support for such retrograde perigraft navigation for type 2 endoleak embolization.