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Common Iliac Artery Aneurysm Repair Using a Sac-Anchoring Endograft to Preserve the Internal Iliac Artery

Purpose: To report the application of the Nellix endovascular aneurysm sealing system to successfully treat a unilateral common iliac aneurysm and preserve the internal iliac artery. Case Report: An 85-year-old man presented with right-sided necrosis of the third and fourth toe. Computed tomography angiography (CTA) showed a right 40-mm popliteal aneurysm and a 38-mm left fusiform common iliac artery aneurysm. After endovascular exclusion of the popliteal aneurysm, the Nellix device was positioned to exclude the common iliac artery aneurysm while preserving the internal iliac artery. Postoperative CTA showed no endoleak and a patent internal iliac artery. At 1 year, duplex ultrasound documented a common iliac aneurysm diameter of 32 mm without complications. Conclusion: Endovascular sealing using the Nellix device can be applied to exclude selected common iliac artery aneurysms with an adequate length and a minimal distal neck, with preservation of the internal iliac artery. The endobag can be positioned such that the aneurysm is completely excluded while the orifice of the side branch is not endangered.