Bilateral Aneurysms Research Articles

A Case of Bilateral Common Iliac Aneurysms Treated by EVAR Using Excluder with the Repositioning Function to Preserve the Inferior Mesenteric Artery

A Case of Bilateral Common Iliac Aneurysms Treated by EVAR Using Excluder with the Repositioning Function to Preserve the Inferior Mesenteric Artery

Application of a Three-dimensional Printed Anatomical Model in Presurgical Planning of Surgical Treatment of Brain Aneurysms

Three dimensional (3D) printed models represent innovative tools in anatomy teaching and surgical planning. The present study aimed at generating 3D skull models incorporating middle cerebral artery (MCA) aneurysms and in assessing their anatomical accuracy and utility as training and preoperative planning tools. Two aneurysm models were generated. Initially, a full skull (model A) and subsequently a half skull (model B) using white polyactic acid (PLA) filament incorporating two arterial networks with hard black PLA filament (in model A) and a softer semitransparent filament (in model B). The models were based on computed tomographic angiography (CTA) of a female patient suffering from bilateral unruptured middle cerebral aneurysms. Model A, a high contrast model, was designed for anatomical illustration purposes. Model B was designed to allow for clipping simulations. The anatomical accuracy of the two models compared to CTA was assessed by measuring their dimensions at the neck, proximal, distal branches and fundus, using an electronic micrometer. The utility of the models for the comprehension of the underlying anatomy, pathology and preoperative planning was evaluated by means of online questionnaires following clipping simulations conducted by neurosurgery residents and specialized neurosurgeons. Of the two 3D printed models generated, model B (clipping model) showed the highest degree of anatomical accuracy. The results of the online survey on the utility of the proposed models indicate that the majority of participants accepted the innovation with positive responses and approve the use of 3D printed aneurysm models for preoperative planning and resident training.

ICA Bifurcation Aneurysms: Clinical Features and Surgical Outcome in a Tertiary Referral Center in South India.

To study the clinical profile, imaging features, intra-operative findings, post-operative outcome at discharge and at 6 months in patients with internal carotid artery (ICA) bifurcation aneurysm. Present study is a retrospective analysis of data of patients who underwent surgery for ICA bifurcation aneurysm between the period of 1st January 2011 to 31st December 2015 at our institute. Demographic variable, clinical grade, radiological finding was assessed. Outcome was measured using modified Rankin score (mRs) at discharge and at 6 months follow up. All ICA bifurcation aneurysms were clipped using a standard pterional craniotomy. A total of 28 patients were included in the study out of which 4 had bilateral ICA bifurcation aneurysms. Mean age was 44.15 (age range 14-65) years, with 43.75% of patient were < 40yrs. Multiple aneurysms were seen in 11 (39.28%) patients, with superior projection being the most common in 53.12%. Vasospasm was seen in 12 (42.85%) with 4 patients undergoing chemical angioplasty. At discharge good outcome (mRs < 3) was seen in 4/5 (80%) patients in the un-bled category, whereas 18/23 (78.2%) in bled category. At 6 months follow up, mRs < 3 was seen 4 (100%) patients in unbled category, and 84.21% (16 of 19) patients in bled group. The findings of the present study have shown an increased incidence of bilaterality and multiplicity for ICA bifurcation aneurysms. The direction of the dome of aneurysm and temporary clipping do not affect the treatment outcomes. These aneurysms have excellent outcomes following surgery.

Endovascular treatment of bilateral isolated aneurysm of the internal iliac artery.

Isolated aneurysms of the iliac arteries comprise less than 2% of abdominal aneurysms. The internal iliac artery is involved in 10-30% of cases. In most cases patients are asymptomatic, unless rupture occurs. They can be diagnosed by Doppler ultrasonography, magnetic resonance imaging or, preferably, angiotomography. Significant expansion, diameter of 3 cm or greater, and symptomatic cases are indications for surgery. We present the case of a patient with an incidental ultrasonographic finding of bilateral aneurysm of the internal iliac arteries, both with indications for surgery. The patient was successfully treated with endovascular techniques, first repairing the right internal iliac with a branched iliac stent graft, preserving patency, then embolizing the left internal iliac artery. Knowledge of the various different techniques and devices and their limitations is fundamental to adequate planning of endovascular treatment, even in rare cases.

Endovascular treatment of the patient with vascular type of Ehlers–Danlos syndrome with bilateral dissection stenoses and aneurysms in V3- andV4- segments of vertebral arteries

A case of treatment of a patient with type 4 of Ehlers–Danlos syndrome and bilateral dissection stenoses and aneurysms in V3and V4-segments of vertebral arteries is described. Also another vascular anomaly was verified: the aberrant right subclavian artery (arteria lusoria). Сerebral angiography with dynamic rotation of the neck revealed a bow hunter's syndrom, which consists in the restriction of blood flow in the right vertebral artery when the head is turned to the left. Stage-by-stage endovascular reconstruction of both vertebral arteries was performed. Firstly, LVIS stent was implanted in the left vertebral artery on the level of the dissection lesion. Then, the aneurysm of the left vertebral artery was embolized by detachable coils. Balloon angioplasty was performed in the stented segment with the compliance balloon-catheter Scepter. On the series of angiograms: the aneurysm is totally excluded, the stenosis of the artery is eliminated. After 1 month, the second stage of endovascular treatment in the same volume in the right vertebral artery was performed. At attempts of a hemostasis with the vascular closure device Аngioseal were unsuccessful in both operations. Hemostasis was successfully performed by manual compression of the puncture site. A mutation in the gene COL3A1, responsible for the synthesis of procollagen III type, was confirmed by Ehlers–Danlos syndrome of type 4 (vascular type) at the subsequent genotyping of the patient. The patient's neurological symptoms regressed to a great extent.&#x0D; Endovascular methods can be effective in the treatment of vertebral arteries dissection lesions in patients with vascular type of Ehlers–Danlos syndrome.

Clipping of paraclinoid aneurysms associated with multiple and bilateral aneurysms through contralateral pterional approach

Objective: To investigate the minimally invasive techniques and the indication of paraclinoid aneurysms associated with other aneurysms' clipping via the contralateral approach. Methods: From January 2011 to January 2015, 9 paraclinoid aneurysms associated with other aneurysms were clipped via contralateral approach at the Department of Neurosurgery, Beijing Tiantan Hospital.The records of these patients were analyzed retrospectively to review the clinical outcome and surgical skills. Results: A total of 20 multiple bilateral aneurysms (9 of contralateral paraclinoid aneurysms, 4 of ICA aneurysms, 4 of posterior communicating artery aneurysms, 2 of anterior communicating artery aneurysms and 1 of anterior cerebral artery aneurysm) from 9 patients were clipped successfully through a unilateral pterional craniotomy.All patients with paraclinoid aneurysms who underwent surgery through contralateral approach showed a good recovery.Postoperative digital subtraction angiography or computerized tomography angiography did not show any residual aneurysm.One patients had ipsilateral olfactory nerve injury during operation.One had cerebral ischemia after surgery, and other patients discharged uneventfully.Of the 1 patients with preoperative visual symptoms showed an improvement. No visual function impairment was observed among others. Conclusions: The contralateral approach remains a safe and reliable treatment option for medial directed paraclinoid aneurysms and those associated with bilateral intracranial aneurysms.For bilateral multiple aneurysms associated this kind of paraclinoid aneurysms, consideration may be given to clipping all aneurysms with the contralateral approach.

Abdominal Pain Revealing a Bilateral Idiopathic Aneurysm of Common Iliac Arteries

Abdominal Pain Revealing a Bilateral Idiopathic Aneurysm of Common Iliac Arteries

Pituitary neoplasms associated with intracranial aneurysm: A report of 4 cases and literature review

Objective To summarize the imaging findings, treatment and prognosis of pituitary adenoma associated with intracranial aneurysm. Methods From July 2014 to June 2017, 4 patients (3 females and 1 male) with pituitary macroadenoma associated with intracranial aneurysm were admitted to Neurosurgery Department of the Second Affiliated Hospital of Zhejiang University School of Medicine. Among them, 1 patient had bilateral ophthalmic artery aneurysms and 2 cases had right ophthalmic artery aneurysms. All those 3 cases underwent endovascular treatment of intracranial aneurysms followed by transsphenoidal surgery for pituitary adenomas. The other 1 patient with anterior communicating artery aneurysm underwent successful clipping of aneurysm after removal of pituitary adenoma. Results Of the 4 patients with pituitary adenoma and intracranial aneurysm, 3 underwent endovascular embolization of the aneurysm followed by endoscopic transsphenoidal pituitary adenoma resection. MRI showed no recurrence after resection. Digital subtraction angiography (DSA) was performed and revealed that the aneurysm had no recurrence and a good prognosis. One patient with anterior communicating artery aneurysm, although undergoing aneurysm clipping and pituitary adenoma resection, eventually gave up treatment due to pulmonary infection, resulting in a poor prognosis. Conclusions For patients with pituitary adenoma with high risk factors, it is recommended to perform magnetic resonance angiography (MRA) and/or DSA before surgery. MRI T1 and T2 weighted sequences showing flow shadow is an important factor for pituitary adenoma with intracranial aneurysms. For patients with pituitary adenomas with intracranial aneurysms, one or two stages of surgery should be performed according to the presence or absence of aneurysm, and a relatively good prognosis can be obtained. Key words: Pituitary neoplasms; Intracranial aneurysm; Diagnosis; Treatment; Prognosis

AAN 7. Internal Iliac Artery Flow Preservation With Iliac Branch Device During Endovascular Repair of Aortoiliac Aneurysms: Single Center Experience

Iliac branch devices (IBDs) have become a popular option to preserve internal iliac artery (IIA) flow in patients with ectatic or aneurysmal common iliac arteries during endovascular aneurysm repair. This study aimed to assess the outcomes with the use of this device in a single-center setting. All patients undergoing implantation of a Cook Zenith IBD (Cook Medical, Bloomington, Ind) between January 2010 and May 2018 in our center were included. The IBD was indicated in physically active, anatomically suitable patients with unilateral or bilateral common iliac artery aneurysms with or without aortic aneurysm. Data were collected prospectively. In the study period, 137 IBDs were implanted in 104 patients (133 men; mean age, 67.4 ± 9 years); 33 (32%) patients had a bilateral IBD, 77 (74%) had a simultaneous or previous endovascular repair, and the remaining 27 (26%) had a simultaneous or previous complex endovascular repair. Technical success was 96.4% (132/137), with no early mortality. An upper access was used in 41 (30%) procedures. Twenty (14.6%) patients had a contralateral IIA embolization. Six (4.4%) IIA branches occluded during a mean follow-up of 19 months (one bilateral occlusion and four unilateral). Estimated IIA branch patency at 1 year and 3 years was 97.6% ± 1.8% and 88.8% ± 4.7%, respectively. Of the 10 patients with occluded IIA (5 technical failures and 5 patients with IBD occlusion), 2 suffered persistent buttock claudication. The IBD is a safe and effective technique to preserve IIA flow in patients with challenging distal anatomy and is associated with high technical success and midterm patency.

Ruptured Bilateral Pericallosal Artery Aneurysm in Mirror Position: Case Report

Introduction Pericallosal artery (PA) aneurysms represent 2 to 9% of all intracranial aneurysms, and their management remains difficult. Objective The aim of the present study is to describe the case of an adult woman with subarachnoid hemorrhage and bilateral PA aneurysm in mirror position. Case Report A 46-year-old woman was referred to our institution 20 days after a sudden severe headache. She informed that she was treating her arterial hypertension irregularly, and consumed ∼ 20 cigarettes/day. The patient was neurologically intact at admission. A non-contrast computed tomography (CT) on the first day of the onset of the symptoms revealed hydrocephaly and subarachnoid hemorrhage (Fisher III). An angio-CT/digital subtraction arteriography showed bilateral PA aneurysms in mirror position. The patient was successfully treated with surgery via the right interhemispheric approach (because the surgeon is right-handed); the surgeon performed the proximal control with temporary clipping, and introduced an external ventricular drain at the end of the surgery. The patient was discharged on the fourth postoperative day without any additional neurological deficits or ventricular shunts. Conclusion Ruptured PA aneurysm is a surgically challenging aneurysm due to the many anatomical nuances and risk of rebleeding. However, the operative management of ruptured bilateral PA aneurysms is feasible and effective.

Hypogastric Preservation Using Retrograde Endovascular Bypass

Maintenance of pelvic circulation has been connected to reduced risks of ischemic colitis, buttock claudication, erectile dysfunction, and spinal cord ischemia during the treatment of extensive aortoiliac aneurysmal disease. We evaluate the mid-to-late follow-up of a cohort of patients treated using 1 preservation technique, the endovascular external iliac artery (EIA) to internal iliac artery (IIA) bypass. All patients undergoing elective retrograde EIA-IIA endovascular bypass at a single institution were retrospectively reviewed over a 10-year period from 2006 to 2016. Anatomic inclusion criteria were single or bilateral common iliac artery aneurysms with or without concomitant aortic aneurysm limiting distal landing zone for endovascular repair and an iliac bifurcation angle greater than 45°. Procedures were performed using aortouni-iliac (AUI) endografts extended to 1 EIA (with endovascular occlusion of the ipsilateral hypogastric artery), cross-femoral artery bypass, and retrograde placement of 1 of 3 types of covered stent grafts into the contralateral IIA. In the case of patients with prior open repair, AUI placement was not required. Follow-up surveillance included duplex ultrasound 1 and 6months postoperatively and annually thereafter, with computed tomography scan (with selective contrast usage) 1month postoperatively and annually thereafter. Seventeen patients (mean age 70years, 93% male) were treated over the period studied. Most were treated for primary disease (N=11) while the remainder was secondary interventions following open repair (N=4) or endovascular aneurysm repair (N=2). Nine patients had bilateral common iliac aneurysms, one had bilateral IIA aneurysms, and the remainder had unilateral iliac aneurysmal degeneration with occluded or severely diseased ipsilateral hypogastric arteries. There was no preference for laterality (right iliac N=8, left iliac N=9). Retrograde bypasses were performed using Fluency stent graft (N=1), Viabahn stent graft (N=13), or Gore Excluder limbs (N=3). Additional hypogastric embolization with AUI extension to the EIA (for bilateral common iliac aneurysms) was required in 6 patients. Proximal extension requiring snorkel/fenestration was present in 5 patients. Technical success was 100% with mean operative time was 168min (range 50-300min), and 71cc contrast usage (range 30-115cc). Mean preoperative iliac artery aneurysm size was 4.0cm with iliac bifurcation angle 71° (range 51-102°). Median length of stay was 3days (range 1-13). Over mean follow-up of 29.8months, there were no aorta-related mortalities, 1 EIA-IIA bypass occlusion (asymptomatic), and 1 reintervention (for type II endoleak not attributed to the EIA-IIA bypass). There were no additional endoleaks and no sac growth. The incidence of bowel ischemia, paralysis, and bowel/bladder dysfunction was zero in the series. Retrograde endovascular EIA-IIA bypass provides a low risk, high patency option for preservation of a single hypogastric artery with resultant maintenance of pelvic circulation.

Technical issues and clinical outcomes of endovascular repair of isolated iliac artery aneurysms: A single-center experience.

Isolated iliac artery aneurysms are the relatively uncommon condition. This study aims to evaluate the technical issues and clinical outcomes of endovascular repair in a cohort of isolated iliac artery aneurysms treated. We retrospectively reviewed 22 consecutive patients with isolated iliac artery aneurysms between December 2006 and September 2016. Iliac artery aneurysms were treated in one of the three ways: (1) standard bifurcated aortic stent graft placement with limb extension; (2) coverage of iliac artery aneurysms with covered stent grafts; and (3) embolization of the arterial branches distal to the aneurysms with coils or vascular plugs. Twenty-two patients (20 men) with a mean age 64.7 years underwent endovascular repair during the study period. The median diameter of the isolated iliac artery aneurysms was 5.9 ± 1.7 cm (2.9-9.0 cm). Technical success was 95.5%. Conversion to open surgery was performed in one patient with bilateral internal iliac artery aneurysms. Four patients underwent placement of a bifurcated stent graft. A covered stent graft was deployed in 16 patients, with embolization of internal iliac artery in 14 patients. Simple coil embolization of isolated internal iliac artery aneurysm was performed in one patient. There was one sudden cardiac death on day 4 after the procedure due to heart failure. During the follow-up period (range: 1-50 months, mean 19.8 months), five patients died of causes not related to isolated iliac artery aneurysms, and transient buttock claudication was observed in one patient. Our study documents the safety and effectiveness of endovascular repair of isolated iliac artery aneurysms with low morbidity and mortality.

Diagnosis and Management of Bilateral Uterine Arteries Aneurysm during Puerperium

Background- Uterine artery pseudo aneurysm is a rare but it can be one of complication of cesarean section. If treated inadequately, it may cause profuse life-threatening postpartum hemorrhage. We report a rare case of bilateral uterine arteries pseudoaneurysm that lead to life threatening secondary postpartum hemorrhage. Case- 25 years old, PI, she underwent category 1 caesarean delivery, 55 days later she experienced recurrent massive attack of secondary postpartum hemorrhage. The diagnosis of bilateral uterine arteries aneurysm was made by CT angiograph. It was successfully treated by selective embolization of the bilateral uterine arteries.

Endovascular Treatment of Concurrent Bilateral Common and Internal Iliac Artery Aneurysms with Preserved Pelvic Circulation: Bilateral Iliac Branch Devices with Opposing Single Division Internal Iliac Artery Sparing

An 83-year-old man with bilateral common iliac artery aneurysms (right, 3.0 cm; left, 2.7 cm), bilateral internal iliac artery aneurysms (right, 3.4 cm; left, 2.6 cm), and an abdominal aortic aneurysm (3.8 cm) was treated with an aortobi-iliac stent graft and bilateral iliac branch devices. The internal iliac components were extended into opposing posterior (left) and anterior (right) divisions of the internal iliac artery using stent grafts. Computed tomography angiography demonstrated that all aneurysms decreased or were stable in size with patent stent grafts at 1 month. The patient was asymptomatic without complications of pelvic ischemia at the last clinical follow-up at 6 months.

TCTAP C-066 Left Anterior Descending Artery Chronic Total Occlusion and Collateral Right Coronary Artery Aneurysm

### Patient Initials or Identifier Number Mr. H. ### Relevant Clinical History and Physical Exam This 69-year-old male with poly-cystic kidney disease and hypertension was admitted to our hospital for bilateral iliac aneurysms. Endovascular aneurysm repair was arranged. However, he had chest

Embolectomy Through Aneurysm Wall for Iatrogenic Occlusion of M1 Portion During Coil Embolization: Technical Note for Transaneurysmal Embolectomy

We describe the technique for surgical "transaneurysmal" embolectomy in a patient with subarachnoid hemorrhage and multiple cerebral aneurysms who manifested large-vessel occlusion during coil embolization. An 84-year-old woman with subarachnoid hemorrhage and bilateral internal carotid artery (ICA)-posterior communicating artery and bilateral middle cerebral artery aneurysms (MCAs) was admitted to our institution. We performed clipping to the left ICA and MCAs; however, we could not find the rupture point of both aneurysms. We chose to treat 2 aneurysms on the other side by coil embolization. After complete coil embolization of a right ICA aneurysm, angiograms showed occlusion of the right MCA just proximal to an MCA aneurysm. Considering the risk of bleeding of an untreated MCA distal to the occlusion by endovascular thrombectomy, we performed open transaneurysmal embolectomy at the occlusion site and surgical clipping of the MCA. After cutting the aneurysmal wall, we inserted a suction tube into the cut surface of the aneurysm. The clot was gradually and completely pulled through the cut surface of the aneurysm. Finally, the aneurysm was completely clipped with titanium clips to preserve the M1 and M2 branches. Different from usual surgical thrombectomy, suturing the vessel wall is not required for transaneurysmal embolectomy and the area of brain ischemia is confined. Aneurysms with the fragile wall may rupture during clearance of tissue on the aneurysmal surface, and suction may increase vessel damage. Transaneurysmal thrombectomy may be useful and safe for large-vessel occlusion just distal to cerebral aneurysms.

Gore Iliac Branch Endoprosthesis for treatment of bilateral common iliac artery aneurysms

ObjectiveThe Gore Iliac Branch Endoprosthesis (IBE; W. L. Gore & Associates, Flagstaff, Ariz) has recently been approved by the Food and Drug Administration for treatment of common iliac artery (CIA) aneurysms. Despite early excellent results in clinical trial, none of 63 patients were treated for bilateral iliac aneurysms. The goal of this study was to examine real-world experience using the Gore IBE for bilateral CIA aneurysms. MethodsA retrospective review of an international multicenter (16 U.S., 8 European) experience using the Gore IBE to treat bilateral CIA aneurysms was performed. Cases were limited to those occurring after Food and Drug Administration approval (February 2016) in the United States and after CE mark approval (November 2013) in Europe. Demographics of the patients, presentation, anatomic characteristics, and procedural details were captured. ResultsThere were 47 patients (45 men; mean age, 68 years; range, 41-84 years) treated with bilateral Gore IBEs (27 U.S., 20 European). Six patients (12.7%) were symptomatic and 12 (25.5%) patients were treated primarily for CIA aneurysm (aorta <5.0 cm). Mean CIA diameter was 40.3 mm. Four patients had aneurysmal internal iliac arteries (IIAs). Two of these were sealed proximally at the IIA aneurysm neck and two required coil embolization of IIA branches to achieve seal in the largest first-order branches. Technical success was achieved in 46 patients (97.9%). No type I or type III endoleaks were noted. There was no significant perioperative morbidity or mortality. IIA branch adjunctive stenting was required in four patients (one IIA distal dissection, three kinks). On follow-up imaging available for 40 patients (85.1%; mean, 6.5 months; range, 1-36 months), 12 type II endoleaks (30%) and no type I or type III endoleaks were detected. Two of 80 (2.5%) IIA branches imaged were occluded; one was intentionally sacrificed perioperatively. ConclusionsPreservation of bilateral IIAs in repair of bilateral CIA aneurysms can be performed safely with excellent technical success and short-term patency rates using the Gore IBE device. Limb and branch occlusions are rare, usually are due to kinking, and can almost always be treated successfully with stenting.

Évolution dramatique d’un anévrisme bilatéral de l’artère fémorale chez une fille de 16 ans

Femoral artery aneurysm is a rare entity among the vascular complications of Takayasu's disease. It is sometimes characterized by the risk of serious local complications with hemorrhagic or ischemic event, as well as by a big therapeutic handling difficulty. We report a case of bilateral femoral artery aneurysm in a 16-year-old girl having a dramatic evolution turn after surgical treatment and irreversible limb ischemia.

Occipital lobe infarction: a rare presentation of bilateral giant cavernous carotid aneurysms: a case report

BackgroundCavernous carotid aneurysm (CCA) represents 2–9% of all intracranial aneurysms and 15% of internal carotid artery (ICA) aneurysms; additionally, giant aneurysms are those aneurysms that are > 25 mm in size. Bilateral CCAs account for 11–29% of patients and are commonly associated with structural weaknesses in the ICA wall, secondary to systemic hypertension. CCAs are considered benign lesions, given the low risk for developing major neurologic morbidities (i.e., subarachnoid hemorrhage, cerebral infarction, or carotid cavernous fistula). Moreover, concurrent presentation with posterior circulation cerebral infarction is even rarer, given different circulation territory from CCA. Here, we report on a patient with bilateral giant CCAs who presented with both typical and atypical symptoms.Case presentationAn 88-year-old hypertensive woman presented with acute vertical oblique binocular diplopia, followed by complete ptosis of the right eye. Ophthalmic examination showed dysfunction of the right third, fourth, and sixth cranial nerves. Further examination revealed hypesthesia of the areas supplied by the ophthalmic (V1) and maxillary (V2) branches of the right trigeminal nerve. Bilateral giant cavernous carotid aneurysms, with a concurrent subacute right occipital lobe infarction, were discovered on brain imaging and angiogram. Additionally, a prominent right posterior communicating artery (PCOM) was revealed. Seven months later, clinical improvement with stable radiographic findings was documented without any intervention.ConclusionsDysfunction of the third, fourth, and sixth cranial nerves, and the ophthalmic (V1) and maxillary (V2) branches of the trigeminal nerves, should necessitate brain imaging, with special attention given to the cavernous sinus. Despite unilateral symptomatic presentation, bilateral lesions cannot be excluded solely on the basis of clinical findings. CCA should be included in the differential diagnosis of cavernous sinus lesions. Although rare, ipsilateral posterior circulation cerebral infarction (i.e., occipital lobe infarction) can occur in CCA patients, presumably as a result of distal embolization through an ipsilateral, prominent PCOM. Spontaneous clinical improvement with stable radiographic support may occur.

Endovascular Treatment of Type 1a Endoleak after Treatment of Suspending Rupture of Bilateral Internal Iliac Aneurysms for Preserving the Inferior Mesenteric Artery

An 86-year-old man presented with lower abdominal pain. Enhanced CT revealed large bilateral internal iliac arterial aneurysms. After embolization of the bilateral internal iliac arteries, leg type stent grafts were implanted. 1 month later an enhanced CT showed a type 1a endoleak, so additional endovascular treatment was necessary. A bifurcated type stent graft was lowered into the terminal aorta to bail out the inferior mesenteric artery. The type 1a endoleak disappeared, nor were complications. The use of this simple and easy technique can prevent serious and fatal complications after bilateral internal iliac artery embolization.