Transabdominal sac puncture: A straightforward access to an excluded iliac artery aneurysm.

Iliac artery aneurysms (IAA) associated with abdominal aortic aneurysms (AAA) are found in 10%-20% of AAAs. Isolated internal iliac artery aneurysms (IIAAs) are an uncommon entity, representing 0.3%-0.5% of all intra-abdominal aneurysms, incidentally discovered or late diagnosed with frank rupture. Despite the high mortality, shared and standardized guidelines on treatment management of IIAAs are currently lacking. We report the case of an 82-year-old male diagnosed and managed in our institution for a left internal iliac artery aneurysm excluded after aorto-bisiliac prosthesis surgery. After an initial endovascular attempt, the procedure was converted to a direct transabdominal puncture approach. Post-procedural evaluation demonstrated a clinical success without evidence of aneurismal sac filling and stable aneurysmal sac volume. The viability of transabdominal sac puncture, especially in cases with complex anatomy or when traditional access methods are inadequate, represents a promising alternative, particularly in poor candidates to conventional iliac surgery.