Embolization Of Pseudoaneurysm Research Articles

Coil Embolization of Femoral Pseudoaneurysms in Intravenous Drug Users: An Additional Treatment Modality

This report describes our centers' experience of a new approach using coil embolization for femoral pseudoaneurysms (PSAs) in intravenous drug users (IVDUs). Current treatment options for this challenging patient group include femoral/external iliac artery ligation and excision of the PSA, with or without revascularization. Radiological thrombin injection, endoluminal stent grafting, and coil embolization have not been widely studied in this patient group and are most commonly reserved for sterile PSAs. A series of 6 patients who presented to the vascular surgical department with IVDU-related PSA were treated with coil embolization. We present here their clinical course and outcomes. Ethical approval was not required. Coil embolization alone did not result in a satisfactory outcome. Thirty-three percent of patients required vessel ligation following their initial treatment with coil embolization. However, all patients initially managed with coil embolization, whether as a definitive treatment or temporizing measure to surgery, were discharged home, mobilizing well, with Doppler signals at the ankle. Postoperative claudication was present in 17% of patients. There were no amputations as a direct result of coil embolization. The amputation in this series resulted from triple-vessel ligation without revascularization in a patient mistaken as having a groin abscess. Coil embolization is a potential, less invasive treatment option in selected cases of IVDU PSA. It offers an alternative therapeutic intervention, adding to the armamentarium available to tackle these often challenging patients.

Three Cases of Coil Embolization for Iatrogenic Pseudoaneurysm Following Femoral vein Puncture During Radiofrequency Catheter Ablation

Three Cases of Coil Embolization for Iatrogenic Pseudoaneurysm Following Femoral vein Puncture During Radiofrequency Catheter Ablation

Endovascular Embolization of Post-tonsillectomy Pseudoaneurysm: A Single-Center Case Series.

The aim of this study was to evaluate the efficacy and safety of endovascular embolization of post-tonsillectomy pseudoaneurysm with the usage of monomeric n-butyl-2-cyanoacrylate (NBCA) glue as a first intention. We retrospectively analyzed the technical details and clinical outcome of ten consecutive children presented with delayed post-tonsillectomy bleeding, caused by lingual or facial artery pseudoaneurysm, which was treated by endovascular embolization. Seven patients had lingual artery pseudoaneurysm, and three patients had injury of a common linguo-facial trunk. Eight patients were treated by endovascular embolization using NBCA glue, and two patients had to be embolized using microcoils. All patients were successfully embolized with no clinical complications. One patient suffered from bleeding during the interventional procedure that was controlled by NBCA which infiltrated normal branches with no clinical sequelae. NBCA glue can be used as an effective appropriate embolizing material in endovascular embolization of post-tonsillectomy pseudoaneurysm. However, certain precautions are mandatory to avoid distal infiltration of normal arteries or proximal reflux that may endanger the internal carotid artery. Level 4, case series.

Renal Arterial Pseudoaneurysm After Partial Nephrectomy: Literature Review and Single-Center Analysis of Predictive Factors and Renal Functional Outcomes.

Partial nephrectomy (PN) represents the current surgical standard for T1 tumors. Renal arterial pseudoaneurysm is a rare but potentially life-threatening complication reported after PN. The aim of this study was to identify the factors associated with the occurrence of pseudoaneurysm after PN, specifically focusing on those requiring management with selective embolization. A literature review of the topic was performed. A retrospective review of the institutional PN database was performed from January 2011 to December 2016. Patients who underwent embolization for pseudoaneurysm represented a separated cohort to be compared with other patients (controls). Patients' and tumors' characteristics were considered. Univariable and multivariable analyses were used to test their eventual association with the occurrence of pseudoaneurysm. A total of 1417 cases were evaluated. At a median of 21 days (interquartile range = 10-34), 20 patients (1.4%) developed postoperative pseudoaneurysm. The majority of patients (70%) presented with gross hematuria. The clinical suspicion was confirmed by contrast-enhanced computed tomography scan with angiography. Selective embolization was performed using endovascular coils. Technical success and clinical success rates were 100% and 95%, respectively. No difference was found in percentage estimated glomerular filtration rate (eGFR) preserved between patients who underwent embolization versus controls (median 82.6% versus 86.3%, P = .35). No differences in age, baseline renal function (as assessed by glomerular filtration rate [GFR]), tumor size, and R.E.N.A.L. were found between patients who reported and did not report pseudoaneurysm. In patients who developed pseudoaneurysm, longer operative time (225.6 minutes versus 193 minutes, P = .04), and cold ischemia time (48 minutes versus 29 minutes, P = .03) were reported. In our series, the occurrence of pseudoaneurysm was associated with longer operative and cold ischemia times. In patients who underwent selective embolization, renal function remained comparable with that of controls.

Percutaneous ultrasound-guided balloon-assisted embolization of iatrogenic femoral artery pseudoaneurysms with Glubran®2 cyanoacrylate glue: safety, efficacy and outcomes.

Femoral pseudoaneurysm (PA) is a frequent complication of arterial access for endovascular procedures. Surgery has traditionally been considered as the gold standard of therapy. We aimed to report our experience of percutaneous ultrasound (US)-guided balloon-assisted embolization with cyanoacrylate glue for the treatment of iatrogenic femoral PAs. Retrospective two-center study of patients with femoral iatrogenic PAs treated by N-butyl cyanoacrylate-methacryloxy sulfolane (NBCA-MS) Glubran®2 glue embolization between July 2013 and November 2017. All patients underwent contralateral arterial access with balloon placement of an appropriate size in front of the PA neck before glue/lipiodol embolization in a 1:1 ratio by percutaneous US-guided puncture of the aneurysmal sac under fluoroscopy control. Twenty-three patients (12 females, 11 males; median age, 79 years; range, 18-93 years) were included. Median PA size was 34 mm (range, 17-60 mm). The median time to treatment was 5 days (range, 1-30 days). Twenty patients (86.9%) were successfully treated by glue injection alone. The three remaining patients (13.1%) with persistent PA or associated arterial-venous fistula were immediately treated during the same procedure by additional stent-graft. Then, overall immediate and 1-month clinical success rates were 100%. No surgical conversion was necessary. No recurrence was reported during the median follow-up of 11 months (range, 2-73 months). Two (8.7%) puncture-related complications occurred at the contralateral arterial access site, which spontaneously resolved. No non-target glue embolization occurred. US-guided balloon-assisted glue embolization is safe and effective to treat iatrogenic femoral PAs in most cases, offering complete exclusion of the PA and avoiding the morbidity of open surgery.

Aneurisma Dissecante da Artéria Basilar

A dissecção isolada da artéria basilar é um evento raro e de diagnóstico difícil, além de pior prognóstico em relação aos casos mais comuns de disseção da artéria carótida interna na porção extracraniana. O objetivo desse trabalho é descrever um caso de dissecção isolada da artéria basilar com isquemia pontina, evoluindo com síndrome de encarceramento. Após tratamento endovascular com angioplastia e embolização do pseudoaneurisma apresentou evolução neurológica satisfatória.

A novel minimally invasive method of successful tissue glue injection in patients with iatrogenic pseudoaneurysm.

To investigate the efficacy and safety of ultrasound-guided tissue glue injection for the treatment of iatrogenic femoral artery pseudoaneurysm. The study comprised of nine patients with unsuccessful ultrasound-guided thrombin injection and one patient with rapidly progressing anemia. All patients had undergone recanalization procedures at least twice, including two subjects with a very rapidly enlarging pseudoaneurysm lobe or significant anemia. Tissue glue at a dose of 0.9 ± 0.53 ml was injected under ultrasound guidance in each patient. Complete embolization was achieved in all patients. Follow-up ultrasound performed 24 h later as well as at 1 and 2 weeks did not show recurrent reperfusion of the pseudoaneurysm. Embolization of iatrogenic pseudoaneurysm using tissue glue seems to be an effective technique for the treatment of this complication. It might be considered as a treatment option in case of unsuccessful primary repair by means of thrombin injection orhemorrhagic shock due to rapid aneurysm progression. Advances in knowledge: Patients with multiple recanalizations and those with dynamically enlarging pseudoaneurysm or rapidly progressing anemia are at risk of life-threatening bleeding. An ultrasound-guided tissue glue injection, a novel method for the treatment of femoral artery pseudoaneurysm, might be considered as a treatment option especially in case of primary thrombin injection failure.

Coil migration from the external carotid artery to the internal carotid artery during coil embolization for pseudoaneurysm of the lingual artery

Coil migration from the external carotid artery to the internal carotid artery during coil embolization for pseudoaneurysm of the lingual artery

A Case of Ischemic Gastric Perforation Associated with Embolization of Pseudoaneurysms of the Hepatic and Splenic Arteries after Pancreaticoduodenectomy

A Case of Ischemic Gastric Perforation Associated with Embolization of Pseudoaneurysms of the Hepatic and Splenic Arteries after Pancreaticoduodenectomy

Primary Management of Large Pancreatic Pseudoaneurysm by Ultrasound-Guided Percutaneous Thrombin Injection after Failure of Transarterial Pseudoaneurysm Embolization

AbstractPancreatic pseudoaneurysm is a rare but life-threatening complication secondary to pancreatitis, surgery, trauma, or infection. Early treatment is advocated due to high risk of rupture and bleeding. Surgical treatment has traditionally been the first line but is associated with high morbidity. Transarterial embolization or exclusion is the treatment of choice; however, in cases with failure of endovascular treatment, percutaneous thrombin injection can be used successfully. We present a case of a large pancreatic pseudoaneurysm managed successfully with percutaneous ultrasound-guided thrombin injection after failure of transarterial management.

Spontaneous Resolution of Post-Traumatic Hepatic Artery Pseudoaneurysm Presenting as Hemobilia, Hemocholecystitis and Shock

Background: Post-traumatic hepatic artery pseudoaneurysm is a rare, but life threatening condition. Symptoms can occur days or even months after the trauma. Case Summary: A 12-year-old child was presented to us with complaints of hematemesis, melena and severe right hypochondrium colicky pain for last 2 days. He had a history of blunt abdominal trauma (accidental fall from height) 1-month back requiring admission in outside hospital. At the time of admission to us, the child was hemodynamically unstable. CECT abdomen showed a focal area (14 × 8 mm) of staining in arterial phase was seen in segment 5, suggestive of pseudoaneurysm of right hepatic artery branch. CT angiography confirmed the presence of pseudoaneurysm. He was resuscitated and after hemodynamic stabilization, our interventional cardiology team planned angiographic embolization of pseudoaneurysm. On 3rd day of admission, child developed chicken pox and procedure was deferred for sometime. Repeat CECT Abdomen with CT Angiography (done 10 days after admission and approx 6 wks after trauma) showed complete resolution of pseudoaneurysm. Child was discharged 2 weeks after presentation with significant improvement in liver function tests. The child remained asymptomatic for the next 6 months in follow up. Conclusion: Spontaneous resolution of post-traumatic pseudoaneurysm can occur even in hemodynamically unstable and symptomatic cases (Figure 1). The authors have none to declare.

Novel and Advanced Techniques for Complex IVC Filter Retrieval.

Inferior vena cava (IVC) filter placement is indicated for the treatment of venous thromboembolism (VTE) in patients with a contraindication to or a failure of anticoagulation. With the advent of retrievable IVC filters and their ease of placement, an increasing number of such filters are being inserted for prophylaxis in patients at high risk for VTE. Available data show that only a small number of these filters are retrieved within the recommended period, if at all, prompting the FDA to issue a statement on the need for their timely removal. With prolonged dwell times, advanced techniques may be needed for filter retrieval in up to 60% of the cases. In this article, we review standard and advanced IVC filter retrieval techniques including single-access, dual-access, and dissection techniques. Complicated filter retrievals carry a non-negligible risk for complications such as filter fragmentation and resultant embolization of filter components, venous pseudoaneurysms or stenoses, and breach of the integrity of the caval wall. Careful pre-retrieval assessment of IVC filter position, any significant degree of filter tilting or of hook, and/or strut epithelialization and caval wall penetration by filter components should be considered using dedicated cross-sectional imaging for procedural planning. In complex cases, the risk for retrieval complications should be carefully weighed against the risks of leaving the filter permanently indwelling. The decision to remove an embedded IVC filter using advanced techniques should be individualized to each patient and made with caution, based on the patient's age and existing comorbidities.

Diagnosis and Management of Complications from Percutaneous Biliary Tract Interventions.

Complications related to percutaneous biliary tract interventions (PBTIs) can range from access site discomfort to life-threatening vascular complications. These complications are relatively uncommon, and most of them are self-limiting. However, major complications for which an increased level of patient care and/or a prolonged hospital stay are required and that may lead to death-albeit rarely-can occur. Some of the most common complications related to PBTI include pain, infection, bile leakage, and catheter blockage. These conditions can be easily recognized by using the patient's clinical history and laboratory examination results. However, the more uncommon complications, such as life-threatening hemobilia, acute pancreatitis, and catheter and stent fractures, may have nonspecific clinical manifestations, and the underlying pathologic condition may be found only when it is being sought specifically. It is important that diagnostic and interventional radiologists be aware of the wide spectrum of PBTI-related complications, as early recognition and treatment may prevent catastrophic situations. In addition, knowledge of the different treatment options is essential for guidance in interventional radiology procedures such as transarterial control of hemobilia, imaging-guided direct percutaneous embolization of pseudoaneurysms, and percutaneous treatment of catheter- and stent-related complications such as fractures. The authors review a wide spectrum of complications associated with PBTI and the percutaneous management of these conditions. They also highlight valuable lessons learned from morbidity and mortality rounds at a high-volume tertiary care center. ©RSNA, 2017.

Recurrent bleeding following the renal artery embolization treating post-percutaneous nephrolithotomy hemorrhage: causes and countermeasure

Objective: To explore the causes and countermeasure in recurrent bleeding following the selective renal artery embolization treating post-percutaneous nephrolithotomy hemorrhage. Methods: A total of 334 patients of severe renal hemorrhage associated with percutaneous nephrolithotomy (PCNL) from March 2011 to April 2015 were analyzed retrospectively.All the patients underwent super selective angiography and renal artery embolization.The causes of recurrent hemorrhage were analyzed and principles for diagnosis and embolization were studied. Results: The initial embolization was performed in 329 cases hospitalized in the First Affiliated Hospital of Guangzhou Medical University and 318 cases were successfully stopped bleeding with a hemostatic rate of 96.7 %(318/329). Of total 334 consecutive cases, there were 16 cases of recurrent renal hemorrhage, 11 cases were initially embolized in this hospital, and otherwise the other 5 cases were in other hospitals. Causes of recurrent hemorrhage were missed embolization of tiny pseudoaneurysm (n=12), and two cases of 12, the tiny pseudoaneurysm were feeding by accessory renal arteries, undetected arteriovenous fistula(n=2), recanalization of the embolized arteries (n=2). Conclusion: The causes of recurrent bleeding fallowing the initial selective renal artery embolization treating post-percutaneous nephrolithotomy hemorrhage are varied, and missed embolization of tiny pseudoaneurysm is the major cause of unsuccessful initial renal artery embolization. To strengthen the understanding of tiny pseudoaneurysm is helpful to improve the success rate of hemostasis.

Ендоваскулярна емболізація посттравматичних псевдоаневризм артерій гомілки у молодих осіб (клінічні спостереження)

Aim. To show the effectiveness of endovascular embolization of posttraumatic arterial tibial pseudoaneurysms in the young. Material and Methods. The results of examination and endovascular embolization of arterial posttraumatic pseudoaneusysms in a 14-year-old girl and a 25-year-old man are described. Results and Discussions. In the first case, a 14-year-old girl contracted a closed right tibial fracture in the middle third with dislodgement of the fragments on Feb 10, 2017. The patient underwent internal metal osteosynthesis on Feb 20, 2017. During the intervention, arterial bleeding occurred, which was stopped by massive suturing of the tissues. On March 1, 2017 the child developed a tense formation in the popliteal fossa and shin edema. Posttraumatic pseudoaneurysm of the tibioperonal trunk was confirmed with Doppler investigation. The artery was embolized, and surgical drainage of the popliteal hematoma was performed. In the second case, a 25-year-old man acquired an open left tibial trauma on Nov 27, 2016 with fracture of both bones in the middle third and fragment dislodgement, followed by the Ilizarov apparatus osteosynthesis. On Feb 2, 2017, a tense formation emerged on the posterior surface of the shin. Dopplerography diagnosed pseudoaneurysm of the posterior tibial artery. The latter was embolized. In both cases the arterial posttraumatic pseudoaneurysms were obliterated with sufficient blood supply of the foot via the anterior tibial artery. Conclusions. Endovascular embolization is an effective method for treatment of posttraumatic arterial tibial pseudoaneurysms.

Percutaneous Direct Embolization for Pseudoaneurysm at the Gallbladder Fossa after Cholecystectomy.

Postoperative pseudoaneurysm at the gallbladder fossa is a rare complication of cholecystectomy. The typical clinical presentations of this condition are intraparenchymal or intraperitoneal hemorrhage or rupture into the gastrointestinal tract, and this may be life-threatening. For the treatment of pseudoaneurysms, percutaneous transarterial embolization is considered first-line. We present a case of pseudoaneurysm at the gallbladder following cholecystectomy, which was successfully treated with echo-guided percutaneous transhepatic direct embolization using N-butyl cyanoacrylate, after the failure of transarterial embolization.

Endoscopic ultrasound-guided coil embolization and thrombin injection of bleeding gastroduodenal artery pseudo-aneurysm

Background and Objectives:Gastroduodenal artery (GDA) aneurysms are rare but a potentially fatal condition if rupture occurs. The most common etiology is acute or chronic pancreatitis. The most common clinical presentation is gastrointestinal (GI) hemorrhage secondary to rupture of the aneurysm. Such a complication is not always related to the size of the aneurysm, and therefore, treatment should be planned as soon as a diagnosis is made. Surgical, endovascular, percutaneous, and endoscopic ultrasound (EUS)-guided interventions are used in the treatment of visceral artery pseudo-aneurysms.Methods:A 50-year-old male had an episode of alcohol induced acute moderate severe pancreatitis 1 month back. He presented with melena, requiring six units of blood transfusions for hemodynamic stabilization. After hemodynamic resuscitation, the patient underwent upper GI endoscopy to know the etiology of massive upper GI bleeding. Upper GI endoscopy showed a bulge with overlying ulceration in the second part of the duodenum. Side viewing endoscopy showed a pulsatile bulge with overlying large ulcer. Ultrasound abdomen showed pseudo-aneurysm of size 3.8 cm × 5.6 cm arising from GDA artery. Contrast-enhanced computed tomography abdomen with angiography showed a saccular pseudo-aneurysm of size 4 cm × 6 cm in relation to GDA. EUS from duodenal bulb showed a pseudo-aneurysm of size 4.1 cm × 5.8 cm arising from GDA. Radiological or EUS-guided interventions were considered. The advantages and disadvantages of both procedures were explained. The patient selected the option of EUS-guided coil embolization.Results:Under EUS and fluoroscopy guidance, five coils of 10 mm size were placed within pseudo-aneurysm through 19-gauge EUS needle. After coil embolization, contrast injection into the pseudo-aneurysm showed partial filling of pseudo-aneurysm. Review EUS 1 day after coil embolization showed high flow in the pseudo-aneurysm. Around 30% of pseudo-aneurysm was obliterated. On the 3rd day, 6 mL of human thrombin was (3000 IU) injected during second session of intervention in six boluses of 500 unit each. After thrombin injection, high-velocity flow was confined to the neck and periphery of pseudo-aneurysm. Further 2 mL of thrombin was injected. Immediately after thrombin injection, color Doppler EUS showed complete obliteration of pseudo-aneurysm. Two weeks later, repeat EUS showed completely obliterated pseudo-aneurysm with no flow.Conclusions:This case shows the practical problems of EUS-guided coil embolization of pseudo-aneurysms.

Iatrogenic Vascular Injuries Due to Spinal Surgeries: Endovascular Perspective.

Iatrogenic vascular injuries due to spinal surgeries are rare but serious complications. Surgical management of these injuries is challenging with high morbidity rates. In this study we aim to present the results of endovascular management of iatrogenic vascular injuries due to spinal surgeries. We retrospectively reviewed 11 patients (5 male, 6 female) who had vascular injuries due to cervical and lumbar spinal surgeries. Clinical findings were bleeding (n=5), leg edema (n=6) and right heart failure with severe dyspnea (n=1). The age range of the patients were between 42-67 (mean: 57.1). Six patients were reviewed with imaging before the procedures and the rest of the patients (n=5) were directly referred to the angiography unit for diagnosis and possible endovascular treatment. The types of surgeries were; cervical surgery (n=5) and lumbar disc operation (n=6). The type of vascular injuries were; vertebral artery stenosis (n=1), vertebral artery pseudoaneurysm (n=3), vertebral artery occlusion (n=1) and iliac arteriovenous fistula (n=6). The type of endovascular treatments were; parent artery occlusion (PAO) (n=2), covered stent graft implantation (n=6) and intrasaccular coil embolization of pseudoaneurysm (n=1). The remaining 2 patients were managed conservatively. No major complications or mortality occured during endovascular interventions. No bleeding or ischemia occured in the follow-up period. Iatrogenic vascular injuries due to spinal surgeries are rare but serious complications. Endovascular interventions are safe and effective in the diagnosis and treatment of such vascular injuries.

Percutaneous Direct Needle Puncture and Transcatheter N-butyl Cyanoacrylate Injection Techniques for the Embolization of Pseudoaneurysms and Aneurysms of Arteries Supplying the Hepato-pancreato-biliary System and Gastrointestinal Tract.

Aims:The aim of this study was to evaluate the safety and clinical efficacy of percutaneous direct needle puncture and transcatheter N-butyl cyanoacrylate (NBCA) injection techniques for the embolization of pseudoaneurysms and aneurysms of arteries supplying the hepato-pancreato-biliary (HPB) system and gastrointestinal (GI) tract.Subjects and Methods:A hospital-based cross-sectional retrospective study was conducted, where the study group comprised 11 patients with pseudoaneurysms/aneurysms of arteries supplying the HPB system and GI tract presenting to a tertiary care center from January 2015 to June 2016. Four patients (36.4%) underwent percutaneous direct needle puncture of pseudoaneurysms with NBCA injection, 3 patients (27.3%) underwent transcatheter embolization with NBCA as sole embolic agent, and in 4 patients (36.4%), transcatheter NBCA injection was done along with coil embolization.Results:This retrospective study comprised 11 patients (8 males and 3 females) with mean age of 35.8 years ± 1.6 (standard deviation [SD]). The mean volume of NBCA: ethiodized oil (lipiodol) mixture injected by percutaneous direct needle puncture was 0.62 ml ± 0.25 (SD) (range = 0.5–1 ml), and by transcatheter injection, it was 0.62 ml ± 0.37 (SD) (range = 0.3–1.4 ml). Embolization with NBCA was technically and clinically successful in all patients (100%). No recurrence of bleeding or recurrence of pseudoaneurysm/aneurysm was noted in our study.Conclusions:Percutaneous direct needle puncture of visceral artery pseudoaneurysms and NBCA glue injection and transcatheter NBCA injection for embolization of visceral artery pseudoaneurysms and aneurysms are cost-effective techniques that can be used when coil embolization is not feasible or has failed.

Safety and Efficacy of Coil Embolization in Treating Vascular Complications of Pancreatitis

Introduction: Acute pancreatitis is an acute inflammatory process of the pancreas. Most patients recover without any major sequelae; however a minority of patients have life threatening vascular complications. Vascular complications of pancreatitis include arterial erosion, pseudo aneurysm, ischemic complications, remote vascular complications, venous thrombosis and varices. We studied patients to study safety and efficacy of coil embolization in treating vascular complications pancreatitis and to reduce morbidity and mortality rates. Methods: This prospective study was conducted from July 2014 to February 2016 at Department of Radiology, Government Medical College Nagpur, in which all patients who presented with vascular complications of pancreatitis were enrolled to undergo embolization using coiling, N-butyl cyanoacrylateglue or gluefoam. The patients were followed to see rebleeding and treatment failure rates. Results: 38 patients were included in the study, of which 33 had pseudoaneurysm and 5 had arterial wall erosions. The most common artery involved was splenic artery in both acute and chronic pancreatitis patients. For treatment, only embolization coils were used in 76% of the patients. There were no occurrences of bowel ischemia, hepatic insufficiency, or rupture-related deaths in any of patients in the follow-up period. Conclusions: Results of embolization of pseudoaneurysms with coils showed high success rate and good short & long term outcome. More research is required to search for better embolization materials which can minimize the risk of rebleeds or other complications.