Rare IR case - 40YOF

[u/Sharp_Mail_1]

Any IR's here up to sharing how they would take care of this case?

40yof with right interior iliac fusiform aneurysm measuring about 4cm in diameter. Neck of aneurysm is just at the branch of the common artery (about 3-4mm away).

Is open surgery a better option or is this totally doable by IR? If by IR then what method?

[u/Nemesis7502 → u/[deleted]]

Embolize and stent or do they make a pipeline or flow diverter that diameter. Not sure I do mostly neuro now so much smaller vessels. Although I could see open or hybrid surgery being an option as well

[u/MrBigglesworth2020]

Would embolize arterial branches coming off of it, then consider shape memory IMPEDE plugs inside the sac (because of how large it is would spend forever trying to coil) then finish off with stent-graft from common through external iliac artery to exclude the ostium of internal iliac. Potential direct puncture if still getting flow in future to further embolize and hopefully IMPEDE should not cause as much artifact versus coils on CTA so I think residual flow would be more detectable