Retrograde filling of an internal iliac artery aneurysm via the profunda femoris artery: A case report of type IIa endoleak.

INTRODUCTION

Internal iliac artery aneurysms (IIAAs) are an uncommon but clinically significant vascular condition that can lead to life-threatening complications, such as rupture and endoleaks, following endovascular repair. Endoleaks particularly type IIa, occur when there is retrograde flow into the aneurysm sac from collateral vessels, and their presence can jeopardize the success of repair procedures. This case report illustrates a rare occurrence of a type IIa endoleak attributed to retrograde filling from the profunda femoris artery, providing insights into the diagnostic complexities and management of IIAAs.

CASE PRESENTATION: A 32-year-old male with a history of hypertension and end-stage renal disease, who was incidentally found to have a large, partially thrombosed IIAA while undergoing evaluation for kidney transplantation. The initial endovascular treatment effectively excluded the aneurysm, but a type IIa endoleak with retrograde filling from the profunda femoris artery was identified during follow-up imaging. Despite attempts at endovascular embolization, the endoleak persisted, leading to a decision for open surgical intervention. The surgical procedure successfully resolved the endoleak and decompressed the aneurysm.

DISCUSSION: This case highlights the complexities of managing IIAAs and the potential for unusual collateral flows to complicate endovascular treatments, underscoring the importance of tailored surgical strategies and the need for close postoperative monitoring.

CONCLUSION

This case illustrates the need for heightened awareness of the profunda femoris artery as a potential source of type IIa endoleaks in the context of internal iliac artery aneurysms.