Internal iliac artery aneurysm embolization with direct percutaneous puncture and thrombin injection

Endoleak it is the most common complication after endovascular abdominal aortic aneurysm repair and it represents the failure of endovascular treatment. In particular type 2 endoleak is associated with retrograde flow in the aneurysm sac from one or more arterial branches. We describe a reperfusion of the aortic aneurysm sac with slow-flow type II endoleak from the right internal iliac artery aneurysm through the posterior door previously closed with coils, and treatment with direct puncture of the internal iliac artery aneurysm with infixion of human thrombin under ultrasound guidance, not previously described in the literature. In this case the direct puncture of the aneurysm sac was the faster and safer way to treat this patient just because the back door was closed by coils and the entry by the iliac graft. Thrombin reduces significantly the presence of artifacts and give to us the exact extension of thrombosis into the aneurysm sac and the echo-guided offers the advantage of being able to monitor the progression of the thrombotic process induced by thrombin injection in real time.