Direct sonographic-guided superior gluteal artery access for treatment of a previously treated expanding internal iliac artery aneurysm

Isolated internal iliac artery aneurysms are relatively uncommon compared with all aortoiliac aneurysms. Transcatheter treatment with coil embolization is an attractive noninvasive alternative to surgical resection. However, if the aneurysm is insufficiently treated with only proximal coil embolization without concurrent embolization of distal runoff vessels, there is a risk of aneurysm expansion from retrograde collateral flow. We present a case of previously treated internal iliac aneurysm that underwent late rapid expansion. Due to occlusion of the internal iliac artery, direct sonographic-guided puncture of the superior gluteal artery was made in order to access the aneurysm. We believe this is the first reported case of such treatment