Abstract
PurposeVisceral artery pseudoaneurysms (VAPAs) are uncommon in clinical practice but may have serious clinical outcomes up to death. Endovascular management is a safe effective alternative option to traditional surgical procedures. This study assesses the outcome of different embolic materials and techniques used in the endovascular management of VAPAs.Materials and methodsThis is a two-center retrospective analysis of endovascular embolisation of 46 VAPAs, with a mean pseudoaneurysm size of 13 ± 11.35 mm, that were urgently managed between July 2018 and March 2020. Patients’ presentations were GIT hemorrhage, intrabdominal hemorrhage, hematuria, and abdominal pain in 34.78%, 30.43%, 23.91%, and 10.87% respectively. Management using coils only was done in 28/46 patients (60.87%), NBCA glue only in 16/46 patients (34.78%), combined coils and NBCA glue in 1/46 patient (2.17%), and Amplatzer plugs only in 1 patient (2.17%). The management techniques were sac packing in 9/46 patients (19.57%), inflow occlusion in 28/46 patients (60.87%) and trapping in 9/46 patients (19.57%). All patients were followed-up for 1 year after the procedure.ResultsThe overall clinical success and periprocedural complication rates were 93.48%, and 15.22% respectively, and 30-day mortality was zero. Clinical success was 92.86% in the coil subgroup (n = 28), and 93.75% in the NBCA glue subgroup (n = 16). The technical success rate was 100%. Effectiveness of the procedures during the follow-up was 97.83%. Target lesion re-intervention rate was 2.17%.ConclusionTransarterial embolisation can provide high technical and clinical success rates with low periprocedural complication and re-intervention rates, as well as satisfactory procedure effectiveness in the management of VAPAs.
Highlights
Visceral artery aneurysms (VAAs) typically occur within celiac trunk and its branches, superior or inferior mesenteric arteries and renal arteries
The imaging appearance of visceral artery pseudoaneurysms (VAPAs) is similar to that of true aneurysms, but typically exhibit more irregular margins, and the pseudoaneurysm is typically surrounded by a hematoma (Jesinger et al 2013)
In lesions managed through sac packing technique (n = 9), clinical success was achieved in 7/9 patients (77.78%), while in lesions managed through inflow occlusion (n = 28) and trapping techniques (n = 9), clinical success was achieved in 27/28 (96.43%), and 9/9 (100%) of the patients, respectively
Summary
Visceral artery aneurysms (VAAs) typically occur within celiac trunk and its branches, superior or inferior mesenteric arteries and renal arteries. Unlike true aneurysms (2021) 4:60 rarity of true visceral artery aneurysms, pseudoaneurysms are more frequently encountered in specialized centers dealing with acute trauma patients or high volumes of abdominal interventions than true aneurysms that are often incidentally discovered (Jesinger et al 2013). The imaging appearance of visceral artery pseudoaneurysms (VAPAs) is similar to that of true aneurysms, but typically exhibit more irregular margins, and the pseudoaneurysm is typically surrounded by a hematoma (Jesinger et al 2013). Up to 70% of pseudoaneurysms and 20% of true aneurysms are liable to rupture and mortality occurs in 25% to 100% (Pitton et al 2015). Eighty per cent of the aneurysms of the hepatic artery are liable to rupture, followed by aneurysms of SMA and pancreaticoduodenal arcades (Bradley et al 2019; van Rijn et al 2017; Durkin et al 2016)
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