Fig. 1a. Unenhanced CT scan demonstrates the proximal extent of the aneurysm.	Fig. 1b. Unenhanced CT scan demonstrates the proximal extent of the aneurysm.

Case Reference No. CC-497-06 A 69-year-old man presented with a symptomatic right common iliac artery aneurysm of approximately 3.5 cm in diameter. Pertinent medical history includes renal insufficiency and a previous heart transplant. Current cardiac function is poor; a pacemaker is present. Deemed a very poor surgical risk by cardiology, the patient underwent surgical femoral-to-femoral artery bypass and high ligation of the right common femoral artery (CFA). This was followed by percutaneous coil embolization of the aneurysm through a high right common femoral artery puncture. At the end of the embolization, the flow was completely stagnant, with thrombosis of the aneurysm as well as the common, internal, and external iliac and common femoral arteries. The patient maintained excellent distal pulses in the left lower extremity and the right foot, via the fem-fem graft. Gadolinium and small amounts of dilute non-ionic contrast material were utilized due to renal insufficiency.

Fig. 2. AP and RAO projections of right CIA injection demonstrate the aneurysm, as well as the internal and external iliac arteries. Fig. 3. Pre- and post-coil embolization images of the right internal iliac artery demonstrate stasis. Fig. 4. Sequence of images demonstrates coil embolization of the aneurysm at the CIA neck (two 20-mm x 20-cm coils), within the aneurysm (multiple various coils), and, finally, the external iliac artery.

Questions 1) Does anyone have any experience with similar treatment of an aneurysm? 2) Would anyone have used a stent-graft to treat this aneurysm, rather than the combined surgical/interventional approach described here? Would anyone use a stent-graft even after the surgical portion of this treatment was performed (ie, CFA ligation)? 3) Would anyone have treated this in some manner other than coil embolization or stent-graft, including a vascular occluder? 4) How would you follow this patient, who, because of a pacemaker and renal insufficiency, cannot undergo MRI nor receive a contrast CT?