Iliolumbar artery

Occasionally, communications between various branches of the IIA and the lumbar arteries may cause retrograde flow into the sac of an aortic aneurysm creating a type-II endoleak. Microcatheter traversal of the entire length of these conununications may not always be possible. Under such circumstances, liquid embolic agents have been employed to occlude the feeder arteries. As mentioned above, this practice may cause ischemic radiculopathy if the targeted vessels are either lateral sacral or iliolumbar arteries. It may be more prudent to coil embo-lize these arteries and use alternative approaches to deal with the possible residual type-II endoleak (see Chap. 14). 

Access to either the contralateral or ipsilateral internal iliac arteries can be facilitated using a Wait-man s loop technique with a Cobra 2 catheter alternatively, a long reverse curve catheter can be used. Care must be taken not to catheterize too distally so as to ensure visualization of the lateral sacral and iliolumbar arteries [50]. Carbon dioxide offers an alternative contrast agent that has the benefits of no allergic reactions, nephrotoxicity, or volume limitations, low cost and flexibility of use with different sized catheters [51-53]. High-pressure contrast injections should be avoided since they may potentially dislodge newly formed clots and result in loss of hemostasis [54]. 

The uterine blood supply is primarily from the uterine arteries. The uterine arteries arise as branches of the internal iliac (hypogastric) arteries. In most cases, the internal iliac artery divides into a posterior division that gives off the iliolumbar, the lateral sacral and the superior gluteal arteries and an anterior division that gives rise to parietal branches (the obturator, inferior gluteal and internal puden-... 

In some situations, the sac can be accessed from internal iliac artery through iliolumbar and lumbar arteries. 

---