Embolization Of Pseudoaneurysm Research Articles

Embolization of Postsurgical Obturator Artery Pseudoaneurysm

The anatomy of the obturator artery in the pelvis makes this vessel and its branches prone to iatrogenic injury during pelvic surgery. We present a postoperative obturator artery pseudoaneurysm treated by transcatheter embolization. Normal and variant obturator vascular anatomy, as well as pathology related to traumatic injury of this vessel, are subsequently discussed.

Coil extrusion after endovascular treatment

scopic sinus surgery. An internal carotid artery (ICA) pseudoaneurysm extending into the sphenoid sinus was treated with coil embolization at another center (Fig. 1A and B). Two years later, the patient noticed platinum coil material in his left nostril. The coil mass was found to have unraveled, with extension of coil material into the nasopharynx (Fig. 1C). After successful test occlusion, the vessel was sacrificed and the sphenoid sinus coil mass was removed (Fig. 1D). The proximity of the carotid artery to the wall of the sphenoid sinus makes the vessel vulnerable to injury during procedures involving the sphenoid sinus.2 In this case, the pseudoaneurysm probably arose from injury to the adventitial layer of the artery and prior sinus infections and may have also weakened the vessel wall.4 The absence of a firm mechanical barrier around the pseudoaneurysm probably contributed to unraveling of the coil mass over time. This case illustrates a potential hazard of coil embolization of pseudoaneurysms that extend into a space without a surrounding mechanical barrier. Platinum coils exert a continuous outward radial force against the wall of the aneurysm. In the treatment of pseudoaneurysms in which there is potential for coil expansion into a paranasal sinus or other “open space,” primary coil embolization of the lesion should not be a first option.1,3 Therapeutic sacrifice of the parent vessel, surgical repair of the pseudoaneurysm if possible, or even embolization with a nonexpansile agent, such as Onyx, may be better strategies.

Therapeutic Embolization for Pseudoaneurysm of the Lateral Inferior Genicular Artery after Total Knee Arthroplasty - A Case Report -

Reports of a traumatic pseudoaneurysm after total knee arthroplasty are quite rare. The authors encountered a case of a traumatic pseudoaneurysm after total knee arthroplasty. The pseudoaneurysm was treated successfully without the need for surgical intervention using transcatheter embolization. No recurrence of the hemarthrosis was observed in the patient after a follow-up of 12 months.

Traumatic pseudoaneurysm of the middle meningeal artery and cerebral intraparenchymal hematoma: case report

Background Pseudoaneuryms of the MMA are rare lesions, accounting for less than 1% of all intracranial aneurysms. Case Description We report a case of a spontaneous intracerebral hematoma that DSA revealed as ispilateral traumatic PMMA. The lesion was managed through an endovascular approach, and definitive embolization of pseudoaneurysm and parent vessel with histoacryl injection was carried out. Recovery and follow-up were uneventful. We discuss the management of those lesions, emphasizing the current neuroendovascular tools and techniques. Conclusion Pseudoaneurysm of the MMA is uncommon but has a potential aggressive natural history. As it can occur with different patterns of intracranial hemorrhage, the external carotid arteries have to be included in hemorrhagic investigational DSA. Once diagnosed, it must be treated. The minimally invasive endovascular approach and definitive embolization of pseudoaneurysm and parent vessel with histoacryl injection are safe and effective.

Selective jejunal artery pseudoaneurysm embolization in a patient with massive gastrointestinal bleeding due to intestinal tuberculosis

Gastrointestinal bleeding is a life-threatening manifestation of intestinal tuberculosis that is generally attributed to oozing of blood from the mucosal ulcers. We report a case of intestinal tuberculosis presenting with massive upper gastrointestinal bleeding from jejunal artery pseudoaneurysm diagnosed with angiography and successfully embolizated by histoacril (glue).

Stent‐assisted detachable coil embolization of pseudoaneurysms in the coronary circulation

Pseudoaneurysms in the coronary circulation are an uncommon occurrence that can develop spontaneously in the setting of atherosclerosis or can develop after catheter-based coronary interventions. The natural history, clinical outcome, and optimal therapy for pseudoaneurysms in the coronary circulation are not clearly established. Recent advances in the techniques and technologies used for endovascular treatment of intracranial aneurysms may be applicable to the management of coronary aneurysms and pseudoaneurysms. We present a case of spontaneous coronary pseudoaneurysm formation after paclitaxel drug-eluting stent implantation and a case of pseudoaneurysm formation in a saphenous vein graft that were both successfully treated with stent-assisted detachable coil embolization.

True giant aneurysm of gastroduodenal artery

Aneurysms affecting the splanchnic arteries are very rare, while the commonest location is splenic artery (10.4%); the gastroduodenal artery (GDA) remains the rarest site representing only 1.5% of more than 3000 reported splanchnic artery aneurysms (SAA) in literature since 1960. Though aneurysms of visceral arteries are rare, awareness and early treatment are important because the common presentation of aneurysmal rupture is associated with a high mortality rate. Majority of the GDA aneurysms documented in the literature are pseudoaneurysms associated with complications of acute or chronic pancreatitis. True giant GDA aneurysms are extremely rare, although there is no standard size criteria to define a giant GDA aneurysm, the term has been used in literature to describe aneurysms above 5 cm in size as shown in Table 1. Several cases of successful coil embolization of GDA pseudoaneurysms were already reported but we

Pseudoaneurysm embolization and vasopressin infusion for lower gastrointestinal bleeding due to recurrence of urinary bladder carcinoma

We report a case that was successfully treated for massive lower gastrointestinal (LGI) bleeding due to a recurrent urinary bladder carcinoma. Treatment consisted of combination therapy including embolization of an inferior gluteal artery (IGA) pseudoaneurysm and low-dose arterial vasopressin infusion via a sigmoid artery (SA). A 57-year-old man presented with life-threatening sudden, massive LGI bleeding due to an obturator lymph node (LN) metastasis from a urinary bladder carcinoma. Computed tomography showed that the LN recurrence had invaded all the way to the sigmoid colon, and there was a pseudoaneurysm with extravasation inside the recurrence. An angiogram revealed a left IGA pseudoaneurysm. We therefore excluded the pseudoaneurysm by embolization with microcoils. Following this treatment the bleeding decreased, but intermittent LGI bleeding continued. Endoscopic examination showed the tumor with a huge ulcer inside the colonic lumen, and continuous oozing was confirmed. A second angiogram showed no recurrence of the IGA pseudoaneurysm and no apparent findings of bleeding. Then a 3F microcatheter was placed in the SA selectively using a coaxial catheter system, and vasopressin was infused at a rate 0.05 U/min for 12 h. Bleeding completely ceased 2 days later. There were no signs of ischemic gastrointestinal complications. Massive LGI bleeding has not recurred in 5 months.

Cholangitis After Coil Embolization of an Iatrogenic Hepatic Artery Pseudoaneurysm

Pseudoaneurysm involving the hepatic arterial system is a recognized complication of biliary surgery. The standard nonsurgical treatment is coil embolization. We present a case of a patient who underwent coil embolization of a pseudoaneurysm and subsequently presented with ascending cholangitis due to migration of coils into the common bile duct.

Endovascular therapy for abdominal pseudoaneurysms: analysis from technical and clinical aspects

To clarify the factors of outcomes by endovascular therapy for abdominal pseudoaneurysm (PSA) from both technical and clinical aspects. Sixteen patients with PSAs underwent embolization. Embolic methods were classified into two groups: proximal and distal embolization (PDE) and proximal embolization alone (PE). The patients were classified into four groups by shock index. Pre-embolization hemoglobin (Hb) level and decrease in Hb level were evaluated. Outcomes were classified into two groups: successful recovery and failure despite successful PSA embolization. There were no statistical differences in success, recurrence, and complication rate, and outcomes between the two embolic methods. There was a statistically significant correlation between the grades of shock indices and outcomes (P<0.05). There was no statistical difference between the Hb levels and outcomes. Outcomes were not dependent on the embolic methods. Shock index reflecting clinical status may be a simple predictor of outcome. PSA should therefore be treated by optimal embolic methods as quickly as possible to avoid rupture.

Angiographic Embolization of a Traumatic Pulmonary Pseudoaneurysm

We present a case report of a 50-year-old male who sustained a gunshot wound to the right chest. The initial thoracotomy demonstrated a nonbleeding gunshot wound in the middle lobe and was otherwise unremarkable. Later that day, after continued resuscitation, his chest tube output dramatically increased and he was taken back for redo thoracotomy. An injury to the lateral branch of the middle lobe pulmonary artery was encountered and suture ligated. The patient presented several weeks later with hemoptysis. Computed tomography of the chest demonstrated pooling of contrast in the middle lobe. Angiography confirmed the diagnosis of a pulmonary artery pseudoaneurysm and was coil embolized without difficulty. This report represents a case of coil embolization of traumatic pulmonary artery pseudoaneurysm.

Femoral nerve palsy secondary to traumatic pseudoaneurysm and iliacus hematoma

The authors report a case of traumatic femoral nerve palsy caused by a pseudoaneurysm of the iliolumbar artery and a iliacus muscle hematoma. This case report details not only the classic history and physical findings seen in patients such as this one, but also illustrates an unusual source of the hematoma and a discussion of its treatment. A 20-year-old man was assaulted and presented to the authors's institution with a 1-week history of severe pain in the left anterior thigh and groin, weakness in the left quadriceps muscle, and numbness in the anterior thigh and medial distal leg. Imaging studies demonstrated a large, 9.4 x 6.4 x 5.2-cm iliacus hematoma as well as a pseudoaneurysm originating from the left iliolumbar artery. The patient underwent angiographic embolization of the pseudoaneurysm followed by surgical evacuation of the hematoma. The embolization was performed before surgery to prevent any possible rebleeding from the pseudoaneurysm during evacuation of the hematoma. Femoral nerve palsy caused by traumatic iliacus hematoma is an infrequent diagnosis often missed because of its insidious presentation. In this case, embolization of the iliolumbar artery pseudoaneurysm followed by surgical evacuation of the hematoma resulted in a nearly full recovery of the femoral nerve as of the last follow-up examination.

Embolization of traumatic pseudoaneurysms after total knee arthroplasty

We report on 2 cases of traumatic pseudoaneurysm after total knee arthroplasty. In one patient, a hemarthrosis and a pulsatile antecubital mass developed 1 month after arthroplasty, prompting angiography. In the second patient, evacuation of a large hemarthrosis was performed before angiography and embolization. In both patients, the pseudoaneurysm was successfully treated without the need for surgical repair, using percutaneous thrombin injection or transcatheter embolization. No recurrence of hemarthrosis was seen in either patient at up to 24 months of follow-up evaluation. These cases show the use of angiography in reconstructed joints when acute or delayed hemarthrosis occurs, and the role of embolization techniques in this setting.

An unusual case of haemobilia

Arterio-biliary fistula is an uncommon cause of haemobilia. We describe a case of right hepatic artery pseudo-aneurysm causing arterio-biliary fistula and presenting as severe melaena and cholangitis. Gastroduodenoscopy failed to establish the exact source of bleeding and hepatic artery angiography and selective embolization of the pseudo-aneurysm successfully controlled the bleeding. Pseudo-aneurysm of the hepatic artery is mostly iatrogenic due to biliary intervention, as demonstrated in this case. Difficulty in diagnosis and management is discussed together with a review of the literature.

Embolization of visceral pseudoaneurysms with platinum coils and N-butyl cyanoacrylate.

We evaluated the efficacy of transcatheter embolization in visceral artery pseudoaneurysms with platinum coils and N-butyl-cyano-acrylate (NBCA). Over the past 7 years, 20 patients were treated by transcatheter embolization in the same sitting with diagnostic angiography. Four right hepatic, one cystic, two gastroduodenal, one cavernosal artery, three superior mesenteric artery branch, and 11 renal artery branch pseudoaneurysms were included in the study. Surgery was completely avoided in 19 patients. In the remaining patient with a superior mesenteric artery branch pseudoaneurysm, endovascular embolization was unsuccessful. Eighteen pseudoaneurysms were thrombosed with coil embolization alone. The remaining three pseudoaneurysms needed NBCA embolization. Two patients died from sepsis within 5 weeks after embolization. Emergent diagnosis and treatment are essential in visceral artery pseudoaneurysms because of the high rate of death. Transcatheter embolization with platinum coils is an efficient, safe treatment of choice. NBCA may be used to avoid proximal embolization of the visceral arteries that could not be catheterized selectively because of tortuosity, vessel size, or anatomic location.

Embolization of Profunda Femoris Artery Branch Pseudoaneurysms with Ethylene Vinyl Alcohol Copolymer (Onyx)

This report describes the use of a new embolic agent, Onyx, which is composed of ethylene vinyl alcohol copolymer dissolved in 8% dimethyl sulfoxide, in the endovascular transcatheter embolization of traumatic profunda femoris artery branch pseudoaneurysms in three cases. Two of the cases involved massive thigh swelling after penetrating injury and the other involved massive hemorrhage at the site of a surgical fixator pin. Diagnostic angiography revealed pseudoaneurysm formation of the profunda femoris artery branches in all cases. Immediate control angiography after the embolization procedures demonstrated complete closure of the pseudoaneurysms. During the follow-up period there was no recurrent bleeding. The advantages of Onyx over conventional liquid embolic agents and coils are discussed.

Transcatheter embolization of splanchnic aneurysms/pseudoaneurysms: early imaging allows detection of incomplete procedure.

The purpose of this work is to discuss results of transcatheter embolization for splanchnic aneurysms/pseudoaneurysms and to evaluate the value of color Doppler ultrasonography and CT within the first week after the procedure. Retrospective review of selected patients from our database with splanchnic artery aneurysms and pseudoaneurysms treated by transcatheter embolization was conducted. Patients were selected and treated in the hospital of Edouard Herriot (Lyon, France). Conventional angiography was performed by the transfemoral route in all patients. We used association of steel coils with or without hemostatic sponge after selective catheterization of the parent vessel for the embolization of the aneurysm. Color flow imaging on ultrasonography and CT scan with contrast medium injection were performed to analyze feeding arteries, treated aneurysm, and presence of complications within the first week after embolization. Eighteen transcatheter embolizations were performed in 14 patients. A total of 25 ultrasonograms and/or CT scans were performed within the first week after the embolization procedure. Complete embolization in one attempt was achieved in eight patients. Imaging follow-up confirmed the absence of recurrence, recanalization, or severe complication for these patients. In one patient, a CT scan with injection of contrast medium done after the first complete procedure of embolization for mycotic pseudoaneurysm identified new aneurysms. Further embolization was done to complete the procedure. In the remaining four patients, large aneurysms were identified, with failure of transcatheter embolization. Follow-up imaging confirmed either the incomplete packing of the aneurysm or recanalization by a new feeding artery. Imaging follow-up with ultrasonography and CT scan provides significant information after transcatheter embolization. We confirm that large visceral aneurysms are difficult to treat by embolization, with failed procedures in our series.

Embolization of proper hepatic artery pseudoaneurysm complicating choledochoscopic laser therapy

Biliary papillomatosis is a rare disease characterized by multiple papillary proliferation of the epithelial cell of the bile duct. Because it has a tendency to be recurrent, the treatment strategy is choledochoscopic laser therapy. A patient with biliary papillomatosis treated by choledochoscopic laser therapy, which was complicated by massive haemobilia and shock, is presented. An intrahepatic artery pseudoaneurysm was diagnosed on angiography. A coexisting occlusion necessitated a superselective embolization of the pseudoaneurysm in order to avoid devascularization of the left lobe of the liver.

Transcatheter Embolization of Pseudoaneurysm of the Profunda Femoris Artery Complicating Fracture of the Femoral Neck

Transcatheter Embolization of Pseudoaneurysm of the Profunda Femoris Artery Complicating Fracture of the Femoral Neck

Imaging guided thoracic interventions.

Interventional Radiology is a technique based medical specialty, using all available imaging modalities (fluoroscopy, ultrasound, computed tomography, magnetic resonance, angiography) for guidance of interventional techniques for diagnostic or therapeutic purposes. Actual, percutaneous transthoracic needle biopsy includes core needle biopsy besides fine needle aspiration. Any pleural, pulmonary or mediastinal fluid or gas collection is amenable to percutaneous pulmonary catheter drainage. Treatment of haemoptysis of the bronchial artery or pulmonary artery origin, transcatheter embolization of pulmonary arteriovenous malformations and pseudoaneurysms, angioplasty and stenting of the superior vena caval system and percutaneous foreign body retrieval are well established routine procedures, precluding unnecessary surgery. These techniques are safe and effective in experienced hands. Computed tomography is helpful in pre- and postoperative imaging of patients being considered for endobronchial stenting. Many procedures can be performed on an outpatient basis, thus increasing the cost-effectiveness of radiologically guided interventions in the thorax.