03:54 PM Abstract No. 244 Direct percutaneous puncture and embolization of visceral pseudoaneurysms: safety and clinical efficacy

Abstract

To assess the safety and clinical efficacy of direct percutaneous puncture and embolization in treatment of visceral pseudoaneurysms. Retrospective analysis of all patients who underwent direct percutaneous puncture of pseudoaneurysm (PSA) and embolization between January 2012 to August 2018 was done. Study included 36 patients (27 male and 9 female) with mean age of 39 years (10-71 years). Indications for direct percutaneous embolization were : difficult catheterization of feeding artery, previous embolization of proximal artery, inability to identify feeding artery on angiography. Patients demography, details of endovascular procedure, complications and clinical outcomes were evaluated. Patients were followed up for recurrence of PSA and symptoms (mean follow : 1-24 months). 28 patients had pancreatitis related PSA, 3 patients had post traumatic PSA, 2 patients had postoperative PSA, 2 PSAs were incidentally detected. Splenic artery was the most commonly involved vessel (n=19). 15 patients had difficult catheterization, 12 patients had prior embolization of feeding artery, in 8 patients feeding artery was not identifiable on angiography and 1 patient had common hepatic artery dissection. NBCA (N-butyl cyanoacrylate) with lipiodol was used in 27 (75%) patients, coils were used in 1 (2.8%) patient and both coils and NBCA were used in 8 (22.2%) patients. Embolization of PSA was successful in all cases except in one case where feeder branch was embolized endovascularly using coils. No major procedure related complications were noted. Recurrent PSA noted in one case which was embolized with NBCA and coil. In another 2 cases, there was recurrence of PSA at sites other than previously embolized. Self limiting splenic infarct was seen in 6 patients. Mild abdominal pain was noted in patients embolized with NBCA. 1 patient developed liver infarct and subsequent liver abscess requiring percutaneous drainage. Direct percutaneous puncture and embolization is a safe and effective treatment of visceral PSAs and can be considered as an alternative treatment in patients with failed endovascular approach. This is the largest study group of direct percutaneous embolizations of visceral PSA.