In situ laser fenestration with coil embolization of expanding internal iliac artery aneurysm following previous stent graft coverage

Abstract We treated a large internal iliac artery (IIA) aneurysm from a type II endoleak with a prior endovascular aortic aneurysm repair (EVAR) and complete coverage of the IIA origin. In situ laser fenestration (ISLF) was used to create temporary access through the iliac limb, allowing selective coil embolization of feeding vessels and the aneurysm sac. The fenestration was then sealed with an iliac stent-graft extension. This case demonstrates that ISLF can provide a safe, fully endovascular option for managing complex type II endoleaks with IIA aneurysm expansion in high-risk patients.