Internal Iliac Artery Research Articles

Validity of Internal Iliac Artery Ligation with Cervico-Isthmic Compression Suture During Conservative Management of Placenta Accreta Spectrum

Validity of Internal Iliac Artery Ligation with Cervico-Isthmic Compression Suture During Conservative Management of Placenta Accreta Spectrum

Endovascular treatment of the gluteal artery pseudoaneurysm: a case report

False aneurysms, also known as pseudoaneurysms, most commonly occur when the main arteries are injured in various ways. False aneurysms of smaller arteries located in the hard-to-reach areas are less common. These include aneurysms of the gluteal arteries. This disorder presents a serious problem due to both difficulties in diagnosis and in determining the tactics of surgical treatment. This article presents a case of successfully treated pseudoaneurysm of the gluteal artery in an elderly patient with underlying severe comorbidities. A 73-year-old patient was admitted to the clinic of vascular surgery with complaints of discomfort and pulsating sensation in the right gluteal region during exercise. Ultrasound examination and multislice computed tomography revealed a false aneurysm in the branch of the internal iliac artery measuring 57 × 36 × 46 mm, which was an indication for surgical treatment. The endovascular treatment scoped implantation of the occluder in the superior gluteal artery. The perioperative period was uneventful. According to the scheduled postoperative examination, the patient's condition was satisfactory. Of practical and clinical interest is the fact that the treatment of this disorder is a technically complex and time-consuming process. In this case, the endovascular treatment of aneurysm with an occluder resulted in an adequate therapeutic effect in the patient with underlying severe comorbidities and reduced the risk of perioperative complications. The patient returned to a normal life within a short time. Received 12 February 2022. Revised 3 April 2022. Accepted 4 April 2022. Informed consent: The patient’s informed consent to use the records for medical purposes is obtained. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsLiterature review: K.P. Moiseev, A.A. VlasovetsDrafting the article: N.V. Susanin, A.G. VanyurkinCritical revision of the article: N.V. SusaninSurgical treatment: M.A. Chernyavskiy, N.V. SusaninFinal approval of the version to be published: N.V. Susanin, M.A. Chernyavskiy, A.G. Vanyurkin, A.A. Vlasovets, K.P. Moiseev

Beyond Total Mesorectal Excision: Compartment-based Anatomy of the Pelvis Revisited for Exenterative Pelvic Surgery.

Magnetic resonance imaging-based subdivision of the pelvis into 7 compartments has been proposed for pelvic exenteration. The aim of the present anatomical study was to describe the topographic anatomy of these compartments and define relevant landmarks and surgical dissection planes. Pelvic anatomy as it relates to exenterative surgery is complex. Demonstration of the topographic peculiarities of the pelvis based on the operative situs is hindered by the inaccessibility of the small pelvis and the tumor bulk itself. Thirteen formalin-fixed pelvic specimens were meticulously dissected according to predefined pelvic compartments. Pelvic exenteration was simulated and illustrated in a stepwise manner. Different access routes were used for optimal demonstration of the regions of interest. All the 7 compartments (peritoneal reflection, anterior above peritoneal reflection, anterior below peritoneal reflection, central, posterior, lateral, inferior) were investigated systematically. The topography of the pelvic fasciae and ligaments; vessels and nerves of the bladder, prostate, uterus, and vagina; the internal iliac artery and vein; the course of the ureter, somatic (obturator nerve, sacral plexus), and autonomic pelvic nerves (inferior hypogastric plexus); pelvic sidewall and floor, ischioanal fossa; and relevant structures for sacrectomy were demonstrated. A systematic approach to pelvic anatomy according to the 7 magnetic resonance imaging-defined compartments clearly revealed crucial anatomical landmarks and key structures facilitating pelvic exenterative surgery. Compartment-based pelvic anatomy proved to be a sound concept for beyond TME surgery and provides a basis for tailored resection procedures.

Internal Iliac Artery Navigation Using Fiber Optic Realshape Technology

Internal Iliac Artery Navigation Using Fiber Optic Realshape Technology

Variations in the origin of iliolumbar artery with its clinical significance

Introduction: The Iliolumbar artery mainly arises from the posterior division of the internal iliac artery. It extends oblique superiorly and laterally in front of the sacroiliac joint and lumbosacral trunk. It crosses the obturator nerve and external iliac vessels & reaches the medial edge of the psoas major. The aim of our study was to know the origin variability of the Iliolumbar artery. This helps to prevent any iatrogenic injury during various surgeries. Materials and Methods: 50 formalin-fixed adult human pelvic halves with known sex were procured from the Department of Anatomy, Medical College, Baroda. Site of origin of the Iliolumbar Artery was identified. Results: In the current study, we observed that the origin of the Iliolumbar Artery was from the posterior division of IIA in 52%, 38% from the trunk of the internal iliac artery, 4% from the single trunk with obturator artery from posterior division, and 6% absent. Conclusion: The variable origins of the ILA from different branches of the internal iliac artery should be taken into account during the surgical procedures involving the lower abdominal & pelvic region so as to modify the surgical tactics to prevent undesired hemorrhagic complications.

Outcomes of “Anterior Versus Posterior Divisional Branches of the Hypogastric Artery as Distal Landing Zone for Iliac Branch Devices”: The International Multicentric R3OYAL Registry

Objective: The aim of this multicentric registry was to assess the outcomes of “anteRior versus posteRior divisional bRanches Of the hYpogastric artery as distAl landing zone for iLiac branch devices (R3OYAL).” Methods: The main exposure of interest for the purpose of this study was the internal iliac artery (IIA) divisional branch (anterior vs posterior) that was used as distal landing zone. Early endpoints included technical success and adverse events. Late endpoints included survival, primary/secondary IIA patency, and IIA branch instability. Results: A total of 171 patients were included in the study, of which 50 received bilateral implantation of iliac branch devices (IBDs). This resulted in a total of 221 incorporated IIAs included in the final analysis, of which 40 were anterior divisional branches and 181 were posterior divisional branches. Technical success was high in both groups (anterior division: 98% vs posterior division: 100%, P = .18). Occurrence of any adverse event was noted in 14% of patients in both groups (P = 1.0). The overall rate of freedom from the composite IBD branch instability did not show significant differences between patients receiving distal landing in the anterior or posterior division of the IIA at 3 years (79% vs 87%, log-rank test = .215). The 3-year estimates of IBD patency were significantly lower in patients who received distal landing in the anterior divisional branch than those who received distal landing in the posterior divisional branch (primary patency: 81% vs 96%, log-rank test = .009; secondary patency: 81% vs 97%, log-rank test < .001). Conclusions: The use of the anterior or posterior divisional branches of the IIA as distal landing zone for IBD implantation shows comparable profiles in terms of immediate technical success, perioperative safety, and side-branch instability up to 3 years. However, IBD patency at 3 years was higher when the distal landing zone was achieved within the posterior divisional branch of the IIA. Clinical Impact The results from this large multicentric registry confirm that use of the anterior or posterior divisional branches of the internal iliac artery (IIA) as distal landing zone for implantation of iliac branch devices (IBD) shows comparable profiles of safety and feasibility, thereby allowing to extend the indications for endovascular repair of aorto-iliac aneurysms to cases with unsuitable anatomy within the IIA main trunk. Although mid-term rates of device durability and branch instability seem to be similar, the rates of primary and secondary IBD patency at three years was favored when the distal landing zone was achieved in the posterior divisional branch of the IIA.

The Pelvic and Sacral Splanchnic Nerves – Identification by Dissection, Trajectory

The modern principles in pelvic surgery imply the preservation of the nervous structures that are involved in the physiological functioning of the pelvic and genital organs. The main pelvic nervous element is represented by the inferior hypogastric plexus. This plexus receives sympathetic afferent fibres from the hypogastric nerve, parasympathetic afferent fibres from the pelvic splanchnic nerves and also sympathetic afferent fibres coming from the sympathetic sacral chain via the sacral splanchnic nerves. We aimed to demonstrate the anatomy of these structures through dissection and we exposed the origins, pathway and manner of distribution of the splanchnic nerves of the pelvis. We managed to clarify the main anatomical relations of these nerves, among which we highlighted the relation to the branches of the internal iliac artery. The parasympathetic fibres reach the pelvis by running through the anterior rami of the spinal nerves, which are the origin of the sacral plexus. We managed to exhibit the way in which the parasympathetic fibres emerge from the sacral nerves and form the pelvic splanchnic nerves. Pelvic surgery nowadays is focused on nerve-sparing, which essentially means the conservation of the integrity of splanchnic nerves, hypogastric nerves and inferior hypogastric plexuses in order to maintain the normal functioning of the anatomical sphincters and genital organs. In this respect, it is crucial for the surgeon who performs pelvic procedures to be more than well-acquainted to the anatomy of the pelvic splanchnic nerves, which are considered to be the erectile nerves, and to that of the sacral splanchnic nerves.

Application of dual-energy CT angiography in diagnosis of arterial erectile dysfunction: new scanning technology, new scanning area

Objectives To explore the value of dual-energy computed tomography (DE-CT) angiography in diagnosis of arteriogenic erectile dysfunction (ED) patients and feasibility of new scanning area that excludes the testis. Materials and methods Ninety-three patients suspected of suffering arterial ED and 40 health volunteers underwent penile duplex Doppler ultrasound and DE-CT angiography (DE-CTA). The scanning range of DE-CTA covered whole arterial system of pelvis and testis was excluded. Two blinded investigators independently evaluated the arterial system that supplies the penis. Results Finally, 1596 segments were evaluated and 470 segments were judged to be abnormal. The distribution was: 2 (0.4%) in common iliac artery, 7 (1.5%) in internal iliac artery, 82 (17.5%) in internal pudendal artery, 89 (18.9%) in penile artery, 120 (25.5%) in dorsal artery, and 170 (36.2%) in cavernosal artery. The specificity, sensitivity, positive predictive value, and negative predictive value of DE-CTA in diagnostic were 86.02%, 87.50%, 94.12%, and 72.92%. Besides, the new scan area allowed for effective evaluation of the arteries while excluding the testis. Conclusion DE-CTA can provide unbiased, safe evaluation of the vascular status of the penile bed in patients with ED.

Successful pregnancy after presurgical uterine artery embolization in the management of a very large cervical myoma: A case report

Although fibroids are the most common benign tumors of the uterus in women of reproductive age, cervical fibroids are rarely seen. Since cervical fibroids are located deep in the pelvis, the incidence of complications in surgery is high. Among these complications bleeding is the most common, due to poor access to myoma, difficulty in suturing and repair, and distortion of vital neighboring structures. Each case should be managed individually to minimize bleeding. To decrease bleeding in patients who wish to retain their fertility, intraoperative interventions include vasoconstrictors such as vasopressin and adrenaline, uterotonics such as oxytocin, misoprostol or ergometrines, uterine artery clamping, internal iliac artery balloon occlusion catheters, and tourniquets; preoperative interventions include gonadotropin releasing-hormone analogues and uterine artery embolization. We present a case of a 40-year-old woman who had a large cervical myoma and a desire for future fertility. To overcome technical difficulties and reduce intraoperative bleeding during myomectomy, presurgical uterine artery embolization was performed. The patient conceived spontaneously after the operation and a healthy baby was delivered by cesarean section.

Selumetinib for Refractory Pulmonary and Gastrointestinal Bleeding in Noonan Syndrome.

A 15-year-old-boy with Noonan syndrome and status post orthoptic heart transplant developed mixed mitral valve disease and underwent mechanical mitral valve replacement 6 months before presentation with acute respiratory distress. He developed massive pulmonary hemorrhage that required veno-venous extracorporeal membrane oxygenation (ECMO) support. He had a prolonged anticoagulation free ECMO course of 4 weeks, with ongoing recurrent pulmonary hemorrhage and underwent several rounds of coil embolization of aortopulmonary collaterals. ECMO course was complicated by significant nasopharyngeal bleeding that required embolization of the sphenopalatine artery. Shortly after decannulation, he developed massive gastrointestinal and peritoneal hemorrhage that was treated by embolization of the left gastric artery and a branch of the internal iliac artery. His bleeding was attributed to neo-angiogenesis. Initial treatment with propranolol was unsuccessful. Subsequent treatment with interferon α 2b demonstrated efficacy, but severe neutropenia required cessation of therapy. Because functional alterations of the rat sarcoma virus-mitogen activated protein kinase signaling pathway and protein tyrosine phosphatase nonreceptor type (PTPN11) mutations in Noonan syndrome are known to be associated with neo-angiogenesis, we used the mitogen-activated protein kinase inhibitor selumetinib as a gene-targeted therapy with the hope of controlling bleeding and inhibiting neo-angiogenesis. After initiation of selumetinib, bleeding stopped and allowed the patient to be discharged from the hospital on dipyridamole as antiplatelet prophylaxis for his mechanical mitral valve. He had no further bleeding episodes through 1 year after hospital discharge.

The role of internal iliac artery intraoperative vascular clamp temporary occlusion in abnormally invasive placenta.

To investigate the efficacy of internal iliac artery intraoperative vascular clamp temporary occlusion in the treatment of abnormally invasive placenta. This retrospective study enrolled 153 patients diagnosed with abnormally invasive placenta between January 2018 and December 2021. The patients were divided into a study group (n= 88, undergoing cesarean section followed by internal iliac artery vascular clamp temporary occlusion) and a control group (n= 65, receiving routine cesarean section). The general situation, intraoperative conditions, postoperative complications, and neonatal outcomes were compared between the two groups. The hysterectomy rate in the study group was significantly lower than that in the control group. However, there were no significant differences in intraoperative blood loss, blood transfusion, postoperative intensive care unit transfer rate, or neonatal outcome between the groups. Further subgrouping showed that in patients with placenta increta, the hysterectomy rate and intraoperative bleeding amount were significantly lower in the occlusion group. Nevertheless, these advantages were not significantly different between the groups in patients with placenta percreta. Vascular clamp temporary occlusion of internal iliac artery is an effective method for controlling hemorrhage and decreasing the incidence of hysterectomy in patients with placenta increta. For patients with placenta percreta, the benefit is limited.

Multidisciplinary Management of Placenta Accreta Avoiding Maternal Mortality in a High-Risk Center- Case Report

Background: Placenta Accreta (PA) constitute a spectrum of abnormal placentation associated with a significant increase in maternal morbidity and mortality. Antenatal diagnosis of PA has transcendental importance in the orientation of the multidisciplinary management showing a substantial reduction in hemorrhagic complications. Case Presentation: A patient of 36.4 weeks of gestation with ultrasound findings of placenta previa and a high probability of placenta increta was attended in our high-risk center. Cesarean section with hysterectomy was performed at 37 weeks. During the surgical procedure, it was found infiltration of the placenta up to the uterine serosa at the level of the uterine segment and adjacent bladder. A hysterotomy at the corpus of the uterus was performed and a healthy newborn was obtained. Ligation of the hypogastric arteries bilaterally and total abdominal hysterectomy was achieved. The patient received a transfusion of red blood cells, platelets, cryoprecipitates and fresh frozen plasma and required vasopressor support with favorable evolution and avoiding fetal and maternal complications. The review of this case highlights that the management by a multidisciplinary team reduces the complications and morbidity-mortality of patients with placenta accreta as it is currently a public health problem. Conclusions: The maternal-perinatal outcomes not only depend on the availability of prenatal diagnosis but also on the organization of this multidisciplinary group with the application of standardized management and providing care in high-risk centers.

Therapeutic effect of Internal iliac artery ligation and uterine artery ligation techniques for bleeding control in placenta accreta spectrum patients: A meta-analysis of 795 patients.

Placenta accreta spectrum (PAS) can cause complications like hysterectomy or death due to massive pelvic bleeding. We aim to evaluate the efficacy of two different arterial ligation techniques in controlling postpartum haemorrhage and minimizing bleeding complications. We searched six databases. 11 studies were finally included into our review and analysis. We graded their quality using the Cochrane tool for randomized trials and the NIH tool for retrospective studies. Our analysis showed that internal iliac artery ligation has no significant effect on bleeding control (MD = −248.60 [−1045.55, 548.35] P = 0.54), while uterine artery ligation significantly reduced the amount of blood loss and preserved the uterus (MD = −260.75, 95% CI [−333.64, −187.86], P < 0.00001). Uterine artery ligation also minimized the need for blood transfusion. Bleeding was best controlled by combining both uterine artery ligation with uterine tamponade (MD = 1694.06 [1675.34, 1712.78], P < 0.00001). This combination also showed a significant decrease in hysterectomy compared to the uterine artery ligation technique alone. Bilateral uterine artery ligation in women with placenta accreta spectrum can effectively reduce the amount of bleeding and the risk of complications. The best bleeding control tested is a combination of both, uterine artery ligation and cervical tamponade. These techniques may offer an easy and applicable way to preserve fertility in PAS patients. Larger randomized trials are needed to define the best technique.

Unconventional Obturator Artery Nutrient Branch: Image of an Anatomical Variation.

Variations in vascular anatomy are of great concern to surgeons, as proper identification of aberrant arteries can reduce the risk of iatrogenic injury and improve patient outcomes. Several studies have highlighted the irregular branching pattern of pelvic arteries, with a recent focus on the obturator artery (OA). The OA has an inconstant origin from the internal iliac artery, external iliac artery, or inferior epigastric artery. Within the pelvis, the OA can give off muscular branches and nutrient vessels to the ilium and pubis. Though occasionally described in text, few resources employ images of human donors that depict branches arising from the OAs. Out of the 34 hemisected pelves studied, we identified 1 individual with a substantial nutrient vessel branching unilaterally from the OA. Herein, we present the first image of this unconventional nutrient artery. This vessel should be highlighted given that its size and course make it particularly vulnerable during intrapelvic surgeries such as pelvic lymph node dissection or in procedures requiring arterial embolization of the OA.

Hypogastric Artery Salvage Associated with Decreased Postoperative Cardiac and Renal Complications

Hypogastric Artery Salvage Associated with Decreased Postoperative Cardiac and Renal Complications

P1. Compression of the lumbosacral trunk and S1 nerve root by calcific posterior branches of the internal iliac artery: a potential source of sciatic pain

<h3>BACKGROUND CONTEXT</h3> Sciatic pain caused by nerve root compression can be painful and debilitating. Compression of the nerve roots comprising the sciatic nerve can occur at their immediate exit from the spinal cord or anywhere along their length. Identifying the precise location of nerve root compression is critical for effective treatment of clinical signs and symptoms. <h3>METHODS</h3> Pelvic dissections were performed on 20 human cadavers (7 males and 13 females) with a mean age of 79.9 years at the time of death (SD, 10.4; range, 63-101 years). The donors were not selected based on any particular medical history or by criteria other than their convenient availability. All of the donors were Caucasians from greater Minnesota. The bodies were embalmed in a solution containing isopropyl alcohol (70%), phenol (13%), formaldehyde (8%), sorbitol (8%) and Barquat MB-50 disinfectant (1%). Each cadaver was sectioned transversely with a handsaw at approximately the L3 vertebral level. The resulting abdominopelvic portion was then sectioned completely down the midline, producing two hemipelvis regions for dissection. The pelvic structures were dissected with conventional dissection instruments (forceps, scalpel, scissors and blunt probe). A Canon EOS Rebel T3i (with a Macro 0.25m/0.8 ft. lens) was used to take photographs during the various phases of each dissection. Both sides of the pelvis were dissected for each cadaver, except for two (due to poor tissue quality). The right side of one could not be dissected due to a large destructive hematoma in the pelvic wall. The left side of another could not be dissected due to tough fibrous adhesions in the pelvis from radiation therapy. <h3>RESULTS</h3> This study of cadaveric hemipelvis dissections provides evidence to support that calcific branches of the internal iliac artery may compress and deform underlying nerve roots. This deformation suggests nerve compression. Specifically, when the posterior division of the internal iliac artery or superior gluteal artery contains calcific plaque, they form a visible impression on the nerves they course over in approximately 85.7% of the time. In this study, the lumbosacral trunk is the most commonly compressed nerve root in the pelvis, but the S1 nerve root can be affected as well. When the blood vessels lacked calcific plaque, they did not produce visible deformation of the underlying nerves. <h3>CONCLUSIONS</h3> Understanding this potential mechanism of nerve compression in the pelvis has clinical significance for patients with sciatic pain. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Bilateral Internal iliac artery ligation: A life saving conservative management to control postpartum haemorrhage- clinical experiences

It has been since long, that severe postpartum haemorrhage (PPH) was surgically treated by peripartum hysterectomy. Bilateral ligation of Internal iliac artery is an emerging technique by which we can control PPH efficiently and can conserve uterus. The aim of our study, is to estimate the effectiveness of bilateral Internal iliac artery ligation (IILA) for conservation of uterus in the management of postpartum haemorrhage and outcome on the patients.This observational study was carried out on the admitted patients in between March, 2016 and February, 2020in a hospital having a tertiary obstetric care. Internal iliac artery ligation done to control postpartum haemorrhage of hospital admitted patients, was our study subject. Collected data were analysed in mean, median, percentage and proportion as applicable by using of SPSS version 24 statistical software.In the study population, out of forty-one patients, uterine conservation was possible in thirty-six (87.8%) patients. Most commonly sixteen (39%) patients had an indication of uterine atony for Internal iliac artery ligation. Caesarean section, thirty-four (82.9%) was the most common mode of delivery and general anaesthesia was used most commonly, thirty-seven (90.2%) for Internal iliac artery ligation. Procedure related complications were e.g. relaparotomy one (2.4%), Internal iliac vein injury two (4.9%) and wound infection two (4.9%).Internal iliac artery ligation is an effective means to control PPH. It can effectively preserve reproductive potential of women by avoiding peripartum hysterectomy in many cases. Postpartum hemorrhage is a life threatening complication of child birth. Peripartum hysterectomy is the last resort to tackle such complications. Our study, confirmed that bilateral internal iliac artery ligation can be a good alternative to tackle such disaster from postpartum hemorrhage and also conserve uterus of women for future reproduction.

Effective dissecting range and prognostic significance of lateral pelvic lymph node dissection for middle-low rectal cancer patients with lateral pelvic lymph node metastasis: Results of a large multicenter lateral node collaborative group in China.

BackgroundLateral pelvic lymph node (LPN) metastasis causes increased lateral local recurrence and poor prognosis. We aimed to investigate the prognostic significance and effective range of dissection for the LPN dissection (LPND) in rectal cancer patients with LPN metastasis.Materials and methodsThrough this large, multicenter retrospective cohort study, we evaluated the therapeutic effect of LPND. From January 2012 to December 2019, 387 rectal cancer patients with clinical evidence of LPN metastasis who underwent total mesorectal excision with LPND were included in the study. According to pathological findings, they were divided into negative (n = 296) and positive (n = 91) LPN groups. Primary endpoints were 3-year overall survival (OS), recurrence-free survival (RFS), and local recurrence-free survival (LRFS).ResultsThe OS, RFS, and LRFS in the positive group were significantly worse than those in the negative group; However, LPN metastases were not independent prognostic risk factors for LRFS (hazard ratio [HR]: 2.42; 95% confidence interval [CI], 0.77–7.64; P=0.132). Among patients with pathological LPN metastases, LPN metastases to the common and external iliac arteries were independent prognostic risk factors both for OS (HR: 4.74; 95% CI, 1.74–12.90; P=0.002) and RFS (HR: 2.70; 95% CI, 1.16–6.29; P=0.021). No significant difference was observed in the 3-year OS (72.3% vs. 70.2%, P=0.775) and RFS rates (60.9% vs. 52.6%, P=0.408) between patients with metastases to the obturator or internal iliac arteries and patients at N2b stage.ConclusionsLPND may be effective in controlling local recurrence in patients with LPN metastasis but not systemic metastases. Patients with LPN metastasis limited to the internal iliac and obturator regions achieve a long-term survival benefit from LPND, and their prognoses may be comparable to those at the N2b stage. Further metastasis to the external iliac or common iliac region should be considered systemic disease, and LPND should be avoided.Clinical Trial Registration ClinicalTrials.gov, identifier NCT04850027.

Peri-adventitial smooth muscle – inheritance of the iliac arterial system?

The histo-morphology of the arterial walls is typically made of 3 distinct layers or tunics designated as intima, media and adventitia. Based on the composition of the media, the arteries are classified into elastic and muscular types. The common iliac artery is an elastic artery, whereas its branches, the external and internal iliac arteries are muscular arteries. In this study, the presence of smooth muscle bundles outside the adventitia was noted in 93 samples taken from the iliac arterial system and the reasons for their presence have been hypothesized.

Treatment of ruptured rectal artery aneurysm in a patient with neurofibromatosis

BackgroundSuperior rectal artery (SRA) aneurysms are rare. Although melena is the most common symptom, it has not been observed in cases of aneurysms located in the SRA trunk. Here, we report a case of a ruptured SRA trunk aneurysm successfully treated with coil embolization. Including our case, three of the four reported cases of SRA trunk aneurysms were related to neurofibromatosis type 1 (NF1).Case presentationA 52-year-old woman with NF1 was referred to our hospital for the investigation of an abdominal mass with back pain. She had previously undergone a blood transfusion at another hospital for anemia without melena. Computed tomography angiography revealed a ruptured SRA trunk aneurysm measuring 3 cm in diameter and surrounded by a retroperitoneal hematoma. The aneurysm was isolated by embolizing the SRA trunk distally and proximally. Distal embolization was performed retrogradely from the internal iliac artery (IIA) via the middle rectal artery (MRA)-SRA anastomosis because the antegrade approach from the inferior mesenteric artery (IMA) failed. To our knowledge, this is the first case of successful coil embolization of an IMA branch through the IIA.ConclusionSRA trunk aneurysms are rare; however, they are frequently associated with NF1. Antegrade distal embolization beyond the aneurysm is sometimes difficult to achieve. In such cases, a retrograde approach via MRA-SRA anastomosis can be the choice for isolating SRA trunk aneurysms.