Development Of Pseudoaneurysm Research Articles

Successful treatment for pseudoaneurysm following distal pancreatectomy with celiac axis resection without postoperative pancreatic fistula: a case report

BackgroundDistal pancreatectomy with celiac axis resection (DP–CAR) represents an innovative surgical approach for locally advanced pancreatic body cancer in cases involving celiac axis invasion. However, this procedure carries significant perioperative risks, including arterial aneurysms and organ ischemia. Understanding these risks is crucial for optimizing patient outcomes and guiding treatment decisions.Case presentationThis case report describes a unique case of a 74-year-old male patient who was diagnosed with locally advanced pancreatic body cancer with invasion of the celiac and splenic arteries. He underwent DP–CAR after six cycles of chemotherapy. His postoperative course was uneventful without any evidence of postoperative pancreatic fistula. However, at the 10-month postoperative follow-up, pseudoaneurysm was incidentally detected in the anterior superior pancreaticoduodenal artery by follow-up computed tomography. It was successfully treated with coil embolization. He had no signs of tumor recurrence or relapse of pseudoaneurysm formation 2 years postoperatively. This case report discusses the potential risks of pseudoaneurysm formation in patients undergoing DP–CAR due to hemodynamic changes. We emphasize the significance of close monitoring in such cases.ConclusionsThe case highlights the importance of recognizing and managing potential complications associated with DP–CAR in patients with pancreatic cancer. Despite its effectiveness in achieving complete resection, DP–CAR carries inherent risks, including the development of pseudoaneurysms. Vigilant surveillance and prompt intervention are crucial for optimizing patient outcomes and minimizing postoperative complications.

Evaluation of the Safety and Efficacy of Coronary Intervention through the Brachial Artery Compared to the Radial Artery in Elderly Patients with Different Extubation Times

Introduction: Percutaneous coronary intervention (PCI) is an important treatment for acute coronary syndrome. The main puncture paths of PCI include radial artery, brachial artery, and femoral artery. The aim of this study was to investigate the safety and efficacy of transbrachial intervention in elderly patients. Methods: According to intraoperative and postoperative nursing records, a retrospective analysis was performed for 70 elderly patients who underwent coronary intervention were divided into brachial artery A group (33 cases) and brachial artery B group (37 cases) according to immediate postoperative extubation compression dressing and 6 hours postoperative extubation compression dressing, and matched elderly patients who had successful transradial artery puncture in the same period as radial artery group (35 cases). The success rate of puncture and catheterization, arterial puncture time, total operation time, length of hospital stay, patient comfort score, incidence of arterial spasm and occlusion, subcutaneous ecchymosis and hematoma, epidermal blister occurrence, vagal reflex, pseudoaneurysm development, arteriovenous fistula formation, nerve damage risk assessment and osteofascial compartment syndrome were compared. Results: Compared with the radial artery group, the brachial artery group (group A and group B) had a higher success rate of puncture and catheterization (97.0% vs. 97.3% vs. 80.0%, p = 0.013), shorter arterial puncture time (2.45 ± 0.38 vs. 2.40 ± 0.35 vs. 3.40 ± 0.37, p = 0.000), and lower incidence of arterial spasm (0.0% vs. 0.0% vs. 34.3%, p = 0.000), arterial occlusion (0.0% vs. 0.0% vs. 14.3%, p = 0.005) and puncture site bleeding (12.1% vs. 5.6% vs. 40.0%, p = 0.001). The incidence of epidermal blister was higher in brachial artery A group than in brachial artery B group (24.2% vs. 2.7%, p = 0.003) or radial artery group (24.2% vs. 0%, p = 0.001), and the incidence of epidermal blister in brachial artery B group and radial artery group was not much different. There was no difference between the three groups in total operation time, length of hospital stay, comfort score, subcutaneous ecchymosis and hematoma, vagal reflex, pseudoaneurysm, arteriovenous fistula, nerve damage and osteofascial compartment syndrome. Conclusion: In elderly patients, coronary intervention through brachial artery is not inferior to radial artery.

Repeat imaging increases detection of delayed pseudoaneurysms in patients with high-grade solid organ injury following abdominal trauma.

Nonoperative management of abdominal trauma can be complicated by the development of delayed pseudoaneurysms. Early intervention reduces the risk of rupture and decreases mortality. The objective of this study is to determine the utility of repeat computed tomography (CT) imaging in detecting delayed pseudoaneurysms in patients with abdominal solid organ injury. A retrospective cohort study reviewing Montreal General Hospital registry between 2013 and 2019. Patients with The American Association for the Surgery of Trauma (AAST) grade 3 or higher solid organ injury following abdominal trauma were identified. A chart review was completed, and demographics, mechanism of injury, Injury Severity Score (ISS) score, AAST injury grade, CT imaging reports, and interventions were collected. Descriptive analysis and logistic regression model were completed. We identified 195 patients with 214 solid organ injuries. The average age was 38.6years; 28.2% were female, 90.3% had blunt trauma, and 9.7% had penetrating trauma. The average ISS score was 25.4 (SD 12.8) in patients without pseudoaneurysms and 19.5 (SD 8.6) in those who subsequently developed pseudoaneurysms. The initial management was nonoperative in 57.0% of the patients; 30.4% had initial angioembolization, and 12.6% went to the operating room. Of the cohort, 11.7% had pseudoaneurysms detected on repeat CT imaging within 72h. Grade 3 represents the majority of the injuries at 68.0%. The majority of these patients underwent angioembolization. In patients with high-grade solid organ injury following abdominal trauma, repeat CT imaging within 72h enabled the detection of delayed development of pseudoaneurysms in 11.7% of injuries. The majority of the patients were asymptomatic.

Delayed appearance of hepatic artery pseudoaneurysm and an arterio-biliary fistula secondary to biliary leakage and bilioma formation in a liver trauma patient and its management through transarterial embolization

BackgroundPseudoaneurysm and arterio-biliary fistulas are infrequent complications of surgery or iatrogenic trauma, accidental trauma, tumors, vascular malformations, infection, and inflammation of the biliary tract. In a liver trauma patient, they evolve immediately secondary to direct vascular injury and usually present with either drop in hemoglobin level or hemobilia due to bleeding into the peritoneal space or biliary system. In the present case, there were no clinical features of hemobilia or upper gastrointestinal bleeding. Moreover, the hepatic artery pseudoaneurysm and arterio-biliary fistula evolved after a latent period of a few weeks, secondary to the toxic effects of the bile on the vessel walls due to biloma formation or biliary leakage, which is exceptionally uncommon.Case presentationThis 19-year-old male presented with a severe liver injury complicated by forming a biloma, followed by the development of a pseudoaneurysm and an arterio-biliary fistula. The appropriate hepatic artery branch was successfully embolized using an endovascular approach.ConclusionsIn a liver trauma patient, the latency period for developing a pseudoaneurysm and an arterio-biliary fistula can be from a few days to a few months due to direct vascular injury or toxic effects of the bile on the adjacent vessel walls secondary to bile leakage. Development of hepatic artery pseudoaneurysm and an arterio-biliary fistula after a latent period of a few weeks, secondary to the toxic effects of the bile on the vessel walls due to biloma formation or biliary leakage, is exceptionally uncommon. So, these liver trauma patients require close monitoring and follow-up for early detection and treatment of pseudoaneurysm and arterio-biliary fistula, especially when there are clinical or imaging features of bile leakage or biloma formation. Endovascular treatment of hepatic artery pseudoaneurysm and arterio-biliary fistulas is a safe and effective method.

Intracerebral Hemorrhage Caused by the Rupture of a Traumatic Pseudoaneurysm in the Middle Meningeal Artery

Hematomas caused by the rupture of a pseudoaneurysm in the middle meningeal artery (MMA) after trauma usually present as epidural hematomas. Intracerebral hemorrhage (ICH) is extremely rare. We reviewed ICH due to the rupture of MMA pseudoaneurysms. We found that in cases of acute ICH, a pseudoaneurysm was attached to the outer surface of the dura mater and associated with dura tear. In patients with acute ICH, the intraoperative rupture of a pseudoaneurysm developed just after bone flap removal. In cases of delayed ICH, pseudoaneurysms adhered to the inner surface of the dura mater. In patients with delayed ICH, the intraoperative rupture of a pseudoaneurysm developed during dura opening and hematoma removal. In situations of dura tear after trauma, the rupture of pseudoaneurysms might lead to ICH via a dura tear. Pseudoaneurysms that develop in the MMA after trauma may exert pressure and result in the thinning of the dura mater. In this case, pseudoaneurysms will adhere to the inner surface of the dura mater after several days or weeks. ICH might develop through both acute and delayed mechanisms following the development of pseudoaneurysms in the MMA. Clinicians should pay attention to the timing of such ruptures during operations for both acute and delayed ICH.

Incidence, clinical course, and risk factors in the development of femoral pseudoaneurysm after atrial fibrillation ablation.

Previous studies have revealed the risk factors for femoral pseudoaneurysms (FPA). Most data on FPA are based on coronary and peripheral interventions, with limited studies focusing on atrial fibrillation (AF) ablation. However, patient backgrounds, anticoagulation regimens, and vascular access methods differ. In addition, a standard for managing FPA after AF ablation remains elusive due to the difficult nature of achieving thrombosis in pseudoaneurysms. This single-center, retrospective, observational study included 2805 consecutive patients who underwent AF ablation between January 2016 and December 2021. All patients underwent femoral artery and vein punctures. Puncture sites were checked 1 day post-procedure. A total of 23 FPA patients were identified during the study period. Multivariate logistic regression analysis showed that hypertension (odds ratio 4.66, 95% confidence interval: 1.38-15.71; p = .0032) and warfarin use (odds ratio 3.83, 95% confidence interval: 1.40-10.45; p = .021) were significantly associated with the occurrence of FPA. The compression success rate was low (22%). There were nine and six patients in the endovascular treatment (EVT) and ultrasound-guided thrombin injection (UGTI) groups, respectively. The success rates were 100% and 84% in the EVT and UGTI groups, respectively. The length of hospital stay after FPA treatment was 2.1 days in the EVT group and 1.3 days in the thrombin group. We must be careful about post-procedural FPA, especially for hypertension and warfarin-using patients. Treatment of pseudoaneurysms with anticoagulants is unlikely to achieve hemostasis, and an early switch to invasive treatments, such as EVT, should be considered.

Spontaneous pseudoaneurysm of the superficial temporal artery in neurofibromatosis type 1: illustrative case.

A pseudoaneurysm of the superficial temporal artery is an uncommon clinical entity that has largely been linked with direct traumatic causes. Neurofibromatosis type 1 (NF1)-related vasculopathy is a rare cause of idiopathic arterial bleeding in the craniofacial region. A 46-year-old male with clinical features of NF1 presented to the hospital with an enlarging and tender right temporal mass without a history of trauma. Computed tomography angiography suggested the development of a pseudoaneurysm, and surgery was performed to resect the mass. Histopathological examinations showed focal interruption of the epithelium layer and elastic lamina, well-demarcated thickening of the smooth muscle layers of the arterial wall, supporting the diagnosis of pseudoaneurysm. NF1-associated vasculopathy is likely the predisposing factor for the development of a superficial temporal artery pseudoaneurysm.

Rapid Development of a Large Pulmonary Pseudoaneurysm in a Segment of Necrotic Lung

Rapid Development of a Large Pulmonary Pseudoaneurysm in a Segment of Necrotic Lung

Surgical Treatment of Traumatic Liver Injury with Development of Biloma, Destructive Cholecystitis and Pseudoaneurysm: a Clinical Case

Introduction. Traumatic liver injury is associated with the danger of developing various insidious complications, with some of them appearing immediately and others — eventually against a background of apparent clinical recovery. Modern sophisticated methods enable the character and localization of liver complications to be accurately revealed and those complications to be stopped by means of minimally invasive techniques. Materials and methods. A clinical case of the traumatic hepatic rupture caused by a fall from height and the subsequent development of successive complications, which, except for the primary surgery — suturing of the liver rupture through laparotomy — were stopped by minimally invasive techniques. Results and discussion. All complications that occurred and were subsequently treated have been divided into seven stages. Stage 1: rapid transfer of the patient to a multidisciplinary hospital. Stage 2: diagnostic laparoscopy followed by laparotomy and suturing of the liver rupture. Stage 3: puncture of the infected biloma. Stage 4: minilaparotomy cholecystectomy. Stage 5: antegrade percutaneous transhepatic drainage of the bile ducts. Stage 6: angiography of the hepatic artery and its branches. Stage 7: endovascular embolization of the pseudoaneurysm cavity. Conclusion. The authors presented the clinical case in order to demonstrate the feasibility and proper application of minimally invasive techniques to manage various complications of liver injury, avoid resection, save life, and preserve quality of life.

Endovascular reconstruction of aortic bifurcation for aortic pseudoaneurysm in a pediatric trauma patient

Endovascular treatment options for vascular injury in pediatric patients are quite limited owing to concerns regarding long-term durability and the lack of devices suitable for the pediatric anatomy. However, in rare circumstances, open surgical therapy will not be an option, and patients will require unconventional endovascular solutions for lifesaving or limb-saving therapies. In the present report, we describe an endovascular treatment of a pediatric patient for whom initial surgical management of a blunt abdominal aortic injury had failed, with subsequent development of an aortic pseudoaneurysm. A 10-year-old girl had presented after a high-speed motor vehicle accident with a seatbelt sign. Multiple abdominal injuries were identified, including blunt aortic injury, significant devitalization of the small bowel, colonic perforation with fecal contamination, multiple lumbar spine fractures, and pulmonary contusions. The patient developed bilateral lower extremity ischemia from the aortic injury and had initially undergone open repair. One month later, the patient had developed a pseudoaneurysm of the aorta near the aortic bifurcation. Because of the hostile abdomen and ensuing short gut syndrome, the pseudoaneurysm was managed using endovascular techniques. The limb of an Excluder internal iliac branch endoprosthesis (W.L. Gore & Associates, Flagstaff, AZ) was used as the endograft. The aortic bifurcation was raised and reconstructed using four Viabahn self-expanding stents (W.L. Gore & Associates). The completion angiogram showed complete resolution of the pseudoaneurysm. The follow-up computed tomography angiogram showed widely patent stent grafts with complete resolution of the pseudoaneurysm. Endovascular management of traumatic vascular injuries in pediatric patients is feasible. The likelihood of reintervention in the future is high with patient growth. However, it is a viable option in lifesaving or limb-saving situations in which open repair is high risk.

Successful Coil Embolization of a Large Anterior Tibial Artery Pseudoaneurysm After Open Reduction Internal Fixation of a Bi-condylar Tibial Plateau Fracture.

Pseudoaneurysms are false aneurysms that consist of turbulent blood flow between the outside layers of the arterial wall, the tunica media and tunica adventitia. Typically, pseudoaneurysms develop after injury to an artery, most often as a result of blunt trauma. Femoral pseudoaneurysms can also develop after catheter-based vascular interventions due to laceration of the artery from access needles, insufficient time or pressure held at the access site after the procedure, amongst other causes. Rarely, arterial injury during orthopedic pinning procedures has been known to cause pseudoaneurysms. There are only two documented cases within the literature in which a patient underwent closed intermedullary nailing of a proximal tibia fracture after trauma and developed an anterior tibial artery pseudoaneurysm. There are few reports of pseudoaneurysm development as the result of external fixation device placement presumably caused by the inability to directly visualize internal anatomy.

Abstract Number ‐ 139: Endovascular Management of Intracranial Pediatric Traumatic Pseudoaneurysms: A Case Series and Systematic Review

Introduction Intracranial pseudoaneurysms (IPA) are rare and potentially life‐altering lesions. Although IPAs represent less than 1% of all intracranial aneurysms, they account for more than 19% of pediatric intracranial aneurysms. The goal of this study was to systematically review the management and outcomes of pediatric patients who developed pseudoaneurysms following head trauma. Methods Following PRISMA guidelines, a systematic literature review was performed using PubMed, EMBASE, OVID Medline and Web of Science databases from date of database inception to May 2022. Studies were selected based on predetermined inclusion and exclusion criteria. Simultaneously, a retrospective analysis was conducted on pediatric patients who underwent endovascular evaluation and treatment for intracranial pseudoaneurysms originating from head trauma at a single institution. Results A total of 221 articles were identified in our review, 51 studies met inclusion criteria. A total of 80 patients were treated for 81 intracranial traumatic pseudoaneurysms, including 5 cases from our institution, with 46 males, 28 females, and a mean age of 9.90 years (range 0.04 ‐18 years). 71 total pseudoaneurysms were the result of external trauma while 10 resulted from iatrogenic trauma. Vessels of the anterior circulation were injured in 75.3% (61/81) of cases. Posterior circulation was involved in 24.7% (20/81) of cases. The internal carotid artery was the most impacted vessel at 45.7% (37/81). The next most common territory injured was the anterior cerebral artery and its distal branches, including the pericallosal and callosomarginal arteries, at 17.3% (14/81). The basilar artery was the third most affected artery, representing 12.3% (10/81) of cases. Hemorrhage was present in 41 patients (51.3%). Subarachnoid hemorrhage was present in 33.8% (27/80), while intracerebral hemorrhage and interventricular hemorrhage (IVH) were present 22.5% and 18.8% of cases, respectively. A total of 92 procedures were performed, with only 8 patients requiring more than 1 procedure for treatment. Only 1 patient required more than 2 procedures. Aneurysm embolization, parent vessel occlusion, parent vessel reconstruction, and aneurysm trapping were performed in 31.5%, 22.8%, 43.5%, and 2.2% of cases, respectively. The intraoperative complication rate was 3.26%, all were ischemic in nature. Two of these ischemic complications resulted focal neurological deficits from parent vessel occlusion. Aneurysm recurrence was encountered in 7 cases, with 6 of these resulting from coil embolization. In patients treated with parent vessel reconstruction, 1 aneurysm ruptured post‐treatment and 2 patients experienced in‐stent thrombosis. Overall, 83.8% of patients had a good neurological outcome and 77.8% of aneurysms were completed occluded on follow‐up imaging. Conclusions The development of pseudoaneurysms in the pediatric population are an important consideration in cases of traumatic head injuries or iatrogenic vessel trauma. These lesions grow rapidly and can carry a high risk of morbidity and mortality if left untreated. Our findings suggest that endovascular treatment of traumatic pseudoaneurysms in the pediatric populations is safe and effective, with high rates of aneurysm occlusion and good neurological outcome. Overall, complications rates are low. Aneurysm embolization can carry an increased risk of aneurysm recurrence.

A rare case of superficial temporal artery pseudoaneurysm in a patient with neurofibromatosis type 1

Pseudoaneurysm of the superficial temporal artery (STA) is a rare clinical entity that has been linked with traumatic causes. Neurofibromatosis type I (NF-1) is an autosomal dominant disorder with known but uncommon vascular abnormalities that comprise stenoses, occlusions, aneurysms, fistulas and arteriovenous malformations. We presented a 46-year-old man with clinical features of NF-1 (e.g., café au lait spots, skin neurofibromas) coming to hospital because of a progressively enlarging and painful right temporal mass of about ping-pong ball size. He remembered having slapping a mosquito with his hands at the same area four days ago. CT angiography suggested development of a pseudoaneurysm and emergency surgery was performed to dissect the mass. Histopathological examination revealed disruption of arterial wall structures, including interruption of elastic lamina, expansion of smooth muscle layer, focal thrombosis and positive CD31 and smooth muscle actin staining, consistent with diagnosis of pseudoaneurysm. This is the first report of a STA pseudoaneurysm in patient with NF-1. Deficiency of neurofibromin may impact the integrity of vascular wall structures and predispose it to the development of pseudoaneurysm in the event of minor trauma like current case. Reference 1. Saliba E, Goldberg LJ. Superficial temporal artery pseudoaneurysm: report of two cases and review. J Cutan Pathol 2022; 49: 482–486.

Feasibility and Safety of Endosonography-Guided Transvascular Needle Aspiration in the Diagnosis of Thoracic and Abdominal Lesions: A Meta-Analysis

Background: Endoscopic techniques, including endobronchial ultrasound (EBUS) and endoscopic ultrasound (EUS), are used as the initial approach for the diagnosis and staging of lung cancer and the diagnosis of thoracic and abdominal lesions. Historically, the transvascular approach has been avoided because of concerns about bleeding. Objectives: This article is a systematic review of studies evaluating the feasibility and safety of transvascular needle aspiration (TVNA) under the guidance of EBUS or EUS in the diagnosis of thoracic and abdominal lesions. Methods: We performed a systematic search of the MEDLINE, Embase, and Cochrane databases to identify studies evaluating the application of EBUS/EUS-guided TVNA (EBUS/EUS-TVNA) for lesions located at the contralateral side of the vessel for which the transvascular approach was the best puncture path. We performed a meta-analysis of diagnostic yield estimations. We also reviewed the complications related to the procedure. Results: Eleven observational studies were included in the final analysis. Meta-analysis yielded a pooled overall diagnostic yield of 82.10% (95% confidence interval, 0.74–0.89) for TVNA, with an I² value of 52%. No publication bias was detected by Egger’s test (p = 0.8528). The overall complications included minor bleeding, minor hematoma, pseudo­aneurysm of the aorta, hemoptysis, acute hypoxic respiratory failure, and moderate bleeding. The major complication rate was 2.71%. Conclusions: EBUS/EUS-TVNA is feasible and probably safe when performed by experienced endoscopists in carefully selected patients. In view of the potential risks associated with the transvascular approach, especially the development of hematoma and pseudoaneurysm, the fanning technique was avoided, and the area of aspiration should be assessed by EUS for 3 min after each aspiration. Most importantly, EBUS/EUS-TVNA should only be performed if the results will impact the clinical management.

Successful Medical-Surgical Management of Intracardiac Thrombosis and Pulmonary Pseudoaneurysms in an Adolescent With Hughes-Stovin Syndrome.

We present an adolescent male with a single intracardiac mass and pulmonary emboli, complicated by peripheral venous thrombosis and subsequent development of pulmonary pseudoaneurysms, leading to diagnosis of Hughes-Stovin syndrome. Remission was achieved with cyclophosphamide, corticosteroids, and pseudoaneurysm resection and maintained with infliximab and methotrexate.

Therapeutic strategies for pseudoaneurysm following blunt liver and spleen injuries: A multicenter cohort study in the pediatric population.

Little guidance exists for the treatment of pseudoaneurysm (PA) following pediatric blunt liver and/or spleen injuries (BLSIs). We aimed to describe the incidence of delayed PA development and the subsequent clinical course of PA in pediatric BLSIs. This multicenter retrospective cohort study from Japan included pediatric patients (16 years and younger) who sustained BLSIs from 2008 to 2019. The cohort was divided into four groups based on hemostatic intervention within 48 hours of admission, namely, nonoperative management (NOM), NOM with interventional radiology (IR), operative management (OM), and combined IR/OM. Descriptive statistics were used to describe the incidence of delayed PA among the groups and to characterize the clinical course of any PAs. A total of 1,407 children (median age, 9 years) from 83 institutions were included. The overall number (incidence) of cases of delayed PA formation was 80 (5.7%), and the number with delayed PA rupture was 16 cases (1.1%) in the entire cohort. Patients treated with NOM (1,056), NOM with IR (276), OM (53), and combined IR/OM (22) developed 43 (4.1%), 32 (12%), 2 (3.8%), and 3 (14%) delayed PAs, respectively. Among patients who developed any PAs, 39% of patients underwent prophylactic IR for unruptured PA, while 13% required emergency angioembolization for delayed PA rupture, with one ruptured case requiring total splenectomy. At least 45% of patients experienced spontaneous resolution of PA without any interventions. Our results suggest that the risk of delayed PA still exists even after acute phase IR as an adjunct to NOM for BLSIs in children, indicating the necessity of a period of further observation. While endovascular interventions are usually successful for PA management, including rupture cases, given the high incidence of spontaneous resolution, the ideal management of PA remains to be investigated in future studies. Therapeutic/Care Management; Level IV.

Acute Development of a Traumatic Pseudoaneurysm of the Posterior Inferior Cerebellar Artery Due to a Fracture of the Clivus

BACKGROUND AND IMPORTANCE: Traumatic intracranial aneurysms are uncommon and are mostly located in the anterior circulation. Aneurysms involving the posterior circulation are extremely rare and account for less than 10% of traumatic aneurysms. In this study, we describe an extremely rare case of a traumatic pseudoaneurysm of the posterior inferior cerebellar artery due to a fracture of the clivus that ruptured in the acute stage after blunt brain injury and that was successfully cured endovascularly. CLINICAL PRESENTATION: A 68-year-old man presented with loss of consciousness because of a severe subarachnoid hemorrhage and multiple contusions after blunt brain injury. Angiography the day after trauma revealed a traumatic pseudoaneurysm near the clivus fracture that had not been identified on the first day of trauma. The aneurysm's location was consistent with the location of the increased thick subarachnoid hemorrhage. The aneurysm was successfully occluded endovascularly through posterior inferior cerebellar artery parent artery occlusion. The patient survived the acute stage because of management that included endovascular treatment followed by decompressive craniectomy. CONCLUSION: A traumatic pseudoaneurysm that is likely to rupture due to the fragility of the aneurysm wall can be identified within 1 day after trauma. Neurosurgeons should pay careful attention to the aneurysm formation and perform early treatment to prevent its rupture, which could lead to a fatal hemorrhage.

S2895 A Rare Case of Inferior Pancreaticoduodenal Artery Pseudoaneurysm Rupture Following Endoscopic Retrograde Cholangiopancreatography

Introduction: Hemorrhage is a known potential complication of endoscopic retrograde cholangiopancreatography (ERCP), often occurring at the site of sphincterotomy. Less commonly, intra- and retroperitoneal hemorrhage can occur secondary to splenic, hepatic, or vascular injury. Here we present a rare case of inferior pancreaticoduodenal artery (IPDA) pseudoaneurysm (PSA) rupture following ERCP in a patient with a large diaphragmatic hernia. Case Description/Methods: The patient is a 68 year old man with a history of hypertension, chronic kidney disease, and splenectomy. He presented with jaundice, fatigue, and labs notable for hypoglycemia, acidemia, acute kidney injury, normal transaminase levels, alkaline phosphatase (129 IU/L), total bilirubin (4.2 mg/dL), direct bilirubin (2.5 mg/dL), and lipase (157 IU/L). Computed tomography (CT) with contrast revealed choledocholithiasis with a 1.2 cm stone in the head of the pancreas associated with pneumobilia, intra- and extrahepatic ductal dilation, and pancreatic ductal dilation. A large left diaphragmatic hernia with protrusion of nonobstructed loops of large and small bowel into the left hemithorax was also noted. He underwent ERCP with biliary sphincterotomy and removal of one stone. One large stone remained. A plastic stent was placed in the common bile duct with plans to repeat ERCP in 4-6 weeks with cholangioscopy and electrohydrolic lithotripsy. Following ERCP, the patient developed acutely worsening anemia without overt evidence of lumenal gastrointestinal bleeding. CT angiography revealed active extravasation and a PSA within an intra-abdominal hematoma (18.4 x 8.5 cm). The patient then underwent mesenteric angiography which showed one multilobulated (2 x 1.8 cm) and one smaller PSA arising from an IPDA branch. Coil embolization of the dominant PSA was performed, achieving hemostasis. (Figure, Table) Discussion: Visceral artery aneurysm (VAA) rupture is an exceedingly rare complication of ERCP with IPDA pseudoaneurysms accounting for just 2% of VAA. Although there is a known association of VAA with pancreatitis, the mechanism for PSA formation following ERCP is unclear. It is thought to be associated with sphincterotomy with rupture caused by direct mechanical injury related to pancreaticobiliary manipulation. Mortality related to VAA rupture and hemorrhage can be as high as 19%. A high index of suspicion and early detection followed by angioembolization are critical for reducing mortality.Figure 1.: (A) CT with contrast showing choledocholithiasis with a 1.2 cm stone in the head of the pancreas. (B) CT angiography showing active extravasation and a pseudoaneurysm (PSA) within an intra-abdominal hematoma (18.4 x 8.5 cm). (C) Mesenteric angiography which showed one multilobulated (2 x 1.8 cm) and one smaller PSA arising from an inferior pancreaticoduodenal artery branch. Table 1 - Summary of currently available case reports of inferior pancreaticoduodenal artery (IPDA) pseudoaneurysm (PSA) development following endoscopic retrograde cholangiopancreatography (ERCP) Age/Sex Comorbidities ERCP Indication Interventions Symptom Diagnosis Treatment Al-Jeroudi et al 2001 76 F None Palliation of pancreatic carcinoma Precut sphincterotomy, biliary stent Abdominal pain IPDA PSA Embolization Rim et al 2021 27 M Sickle cell disease Choledocholithiasis Sphincterotomy, stone extraction, biliary stent, pancreatic duct stent Abdominal pain, acute anemia IPDA PSA rupture Embolization Current Case 68 M Hypertension, chronic kidney disease, diaphragmatic hernia Choledocholithiasis Sphincterotomy, stone extraction, biliary stent Abdominal pain, acute anemia IPDA PSA rupture Embolization

Iatrogenic pseudoaneurysm of the middle meningeal artery during embolization of bilateral chronic subdural hematomas.

Summary/AbstractMiddle meningeal artery embolization has become an important treatment option for chronic subdural hematomas. While the treatment is safe, we present a unique case of development of an iatrogenic middle meningeal artery pseudoaneurysm during endovascular embolization with use of a dual-lumen balloon catheter used for injection of a liquid embolic agent. A 62-year-old man on Coumadin for portal vein thrombosis presented to the hospital with headache and supratherapeutic INR. Imaging revealed bilateral acute on chronic subdural hematomas. Given his medical comorbidities he underwent endovascular middle meningeal artery embolization. During the embolization, angiography revealed a pseudoaneurysm of the middle meningeal artery related to use of a dual-lumen balloon catheter. This pseudoaneurysm was successfully treated with ethylene vinyl alcohol embolization. Intracranial pseudoaneurysm related to balloon catheter use is a rare cause of iatrogenic pseudoaneurysm and could lead to life-threatening intracranial bleeding. Therefore, recognition and timely treatment are important.

Late endovascular coil migration following traumatic pulmonary artery pseudoaneurysm embolization: case report

BackgroundPercutaneous vascular interventions are performed for the treatment of haemoptysis and involve embolization of bronchial arteries, pulmonary arteries and pulmonary arteriovenous malformations. There are isolated reports of embolization of pseudoaneurysms forming in the pulmonary vasculature. The migration of components of the coils used in the embolization of vascular pulmonary pathologies is rare.Case presentationA 46-year-old man presented to the emergency department with cough, haemoptysis, and expectoration of lengths of metal wire. He had an episode of coughing out a wire about a year prior to his admission to our hospital, which he attributed to be present in the can of coke he had consumed at that time and did not report it to the doctors. His past medical history was significant for stab injury to the right chest 17 years ago, for which he underwent right thoracotomy and exploration for bleeding. Injury to the lung parenchyma was noted and repair was performed by suturing the defect. Post operatively the CT scan demonstrated development of pulmonary artery pseudoaneurysm. We report a case of a patient expectorating coils 17 years after embolization of this traumatic pulmonary artery pseudoaneurysm. Radiological imaging demonstrated coils in the perihilar area of the lung parenchyma and in the tracheobronchial lumen. Operative intervention was used to remove the coils.ConclusionsAlthough percutaneous catheter based vascular interventions have emerged as safe and effective procedures, the long-term complications such as coil migration, recanalization and need for further embolization ought to be considered and patients need to be counselled and followed-up accordingly. To the best of our knowledge, this is the first case of migrated coil post embolization of post-traumatic pulmonary artery pseudoaneurysm. Ultimately, the management of endobronchial coil migration post embolization, be it surgical or bronchoscopic, should be decided on a case-by-case basis, considering the patient’s symptoms and the risk fatal complications.