Fig. 3

Haemodynamically unstable 61-year old male patient with history of inoperable bladder cancer, radiotherapy previous EVAR, fem-fem bypass graft and intractable haematuria not responding to any conservative method. a DSA depicting previous unilateral EVAR and extra-anatomic fem-fem bypass. b Selective catheterization of the right internal iliac artery (IIA) demonstrating a significant stenosis of its origin (circle). c DSA with the catheter at the origin of the IIA demonstrating a blush of contrast at the site of bleeding (arrow). d As the anterior division of the IIA could not be selectively catheterized, protective coil embolization of the posterior division (circle) and life-saving particle embolization (40 μm for better penetration) from the origin of the IIA was performed. Note the anastomosis between the right and the left middle and lateral sacral arteries (arrows). e After the delivery of 1 vial of micro-particles no blush was evident (arrow). f and g 30 mins after embolization the patient developed severe pain and marked ischemia of the buttock and the anterior abdominal wall. He was managed by the anaesthesiology team and died of myocardial infarction 10 days after index procedure