Fig. 4

Ruptured IIA aneurysm in a 63-year-old male resulting from persistent type 2 endoleak. A Initial CT demonstrates an isolated IIA aneurysm (white arrow) measuring 42 mm in diameter. B Vascular plugs (black arrows) were placed distally to the bifurcation of the anterior and posterior trunks of the IIA. Not a prominent iliolumbar artery (white arrow) arising proximally to the embolization site. C A vascular plug (black arrow) was placed in the proximal segment of the IIA to interrupt the inflow. D The patient returned 5 years later with a ruptured aneurysm (white arrow). E An iliac stent-graft was deployed over the ostium of the IIA (black arrow) which had previously been embolized with a vascular plug (white circle). F Follow up CT acquired one week later demonstrates persistent endoleak associated with retrograde flow through a patent iliolumbar artery (located between two black arrows). The patient expired three weeks later from multiorgan failure