Enhanced three-dimensional navigation with intraoperative positioning system in coil embolization of complex aneurysm.

A 91-year-old man with chronic kidney disease and multiple comorbidities was incidentally found to have a 5.1 cm left internal iliac artery aneurysm during back pain evaluation. To minimize contrast and radiation, intraoperative positioning system-guided repair was performed. A three-dimensional model was created via preoperative computed tomography angiography and an intraoperative cone-beam computed tomography for electromagnetic tracking. Gluteal branches were cannulated using the intraoperative positioning system and embolized with plugs and coils before deploying a modified Cook Zenith Renu endograft with balloon molding. Completion angiography confirmed exclusion, preserved perfusion, and no endoleak. At 6 weeks, the patient remained stable.