Direct Percutaneous Glue Embolization of the Splenic Artery following Iatrogenic Puncture during CT-Guided Core Needle Biopsy: a Case Report.

Abstract

Background:Direct percutaneous embolization, has been deliberately employed before on various occasions. However, to our knowledge, there is no report in the literature, of its use in order to achieve urgent hemostasis after iatrogenic erroneous arterial puncture. Case presentation: A 75-year-old female patient underwent a CT-guided biopsy of a pancreatic body necrotic mass encasing the patent splenic artery and thrombosed splenic vein. Following the second biopsy needle pass, brisk arterial flow occurred through the 17G coaxial needle, raising concern for a splenic artery puncture. The central stylet was instantly repositioned into the coaxial needle in order to tamponade the bleeding, while a mixture of glue/lipiodol (1:3 ratio) was prepared. The mixture was injected through the coaxial needle while the latter remained in its position and while it was being withdrawn from the abdomen, in order to achieve track sealing. CT angiography revealed a hyperdense-embolic material in the course of the coaxial system throughout the lumen of the splenic artery/intrasplenic branches and in the gastrohepatic space. Additionally, reduced/absent flow was noted in the splenic artery, while almost no contrast enhancement was eminent in the splenic parenchyma. Importantly, no contrast extravasation or additional complications were noted. The patient remained hemodynamically stable, with no drop of the Hct/Hb counts and no clinical signs or symptoms of bleeding throughout the procedure and remaining hospitalization. Conclusions:Percutaneous, direct glue embolization of the splenic artery following its erroneous puncture with a 17G coaxial needle was fast, safe and effective, resulting though in asymptomatic occlusion of a large volume of splenic parenchyma.