Transcatheter Coil Embolization of Splenic Artery Aneurysm

The purpose of this study was to evaluate clinical results and technical problems of transcatheter coil embolization for splenic artery aneurysm. Subjects were 16 patients (8 men, 8 women; age range, 40-80 years) who underwent transcatheter embolization for splenic artery aneurysm (14 true aneurysms, 2 false aneurysms) at one of our hospitals during the period January 1997 through July 2005. Two aneurysms (12.5%) were diagnosed at the time of rupture. Multiple splenic aneurysms were found in seven patients. Aneurysms were classified by site as proximal (or strictly ostial) (n = 3), middle (n = 3), or hilar (n = 10). The indication for transcatheter arterial embolization was a false or true aneurysm 20 mm in diameter. Embolic materials were fibered coils and interlocking detachable coils. Embolization was performed by the isolation technique, the packing technique, or both. Technically, all aneurysms were devascularized without severe complications. Embolized aneurysms were 6–40 mm in diameter (mean, 25 mm). Overall, the primary technical success rate was 88% (14 of 16 patients). In the remaining 2 patients (12.5%), partial recanalization occurred, and re-embolization was performed. The secondary technical success rate was 100%. Seven (44%) of the 16 study patients suffered partial splenic infarction. Intrasplenic branching originating from the aneurysm was observed in five patients. We conclude that transcatheter coil embolization should be the initial treatment of choice for splenic artery aneurysm.     

Coil Embolization of the Splenic Artery: Impact on Splenic Volume

PurposeTo determine the impact of coil embolization of the splenic artery on splenic volume based on computed tomography (CT) imaging.Materials and MethodsSplenic artery embolization (SAE) was performed in 148 consecutive patients over an 8-year period in an institutional review board–approved retrospective study. Of these, 60 patients (36 men; mean age, 49 y) had undergone contrast-enhanced CT before and after SAE with a mean time interval of 355 days. Pre- and postembolization splenic volumes were calculated with volume-rendering software. Presence of Howell–Jolly bodies was ascertained on laboratory tests. A trauma control group consisted of 39 patients with splenic laceration and follow-up CT but no splenic intervention.ResultsSAE in trauma patients resulted in an insignificant decrease in mean spleen size from 224 cm³ to 190 cm³ (P = .222). However, postembolization splenic volume was significantly smaller than follow-up volume in the trauma control group (353 cm³; P < .001). In nontrauma patients, the mean splenic volume decreased from 474 cm³ to 399 cm³ after SAE (P = .068). Multivariable analysis revealed that coil pack location was the only factor significantly affecting resultant splenic volume (P = .016). For trauma and nontrauma patients, distal embolization resulted in significant splenic volume loss (P = .034 and P = .013), whereas proximal embolization did not. No patients had persistent circulating Howell–Jolly bodies after SAE. No patients required repeat embolization or splenectomy.ConclusionsCoil embolization of the splenic artery resulted in a modest but significant decrease in splenic volume when performed distally; proximal embolization resulted in an insignificant volume change.     

Percutaneous Injection Therapy for a Peripheral Pulmonary Artery Pseudoaneurysm After Failed Transcatheter Coil Embolization

Coil embolization to occlude the feeding artery of a pseudoaneurysm is an effective treatment to control hemoptysis. However, a feeding artery of the pseudoaneurysm may not be identified at pulmonary angiography, resulting in a failure to obtain embolization. We describe here two cases of a Rasmussen aneurysm that was successfully treated with percutaneous injection of thrombin (case 1) and N-butyl cyanoacrylate (case 2) under ultrasonographic and fluoroscopic guidance after failed transcatheter coil embolization.     

Treatment of a Splenic Artery Pseudoaneurysm by Endoscopic Ultrasound-Guided Thrombin Injection

We present a case of a splenic artery pseudoaneurysm secondary to pancreatitis that was successfully treated by transgastric injection of thrombin under endoscopic ultrasound guidance. There has been no recurrence on follow-up CT angiography, and thus complex surgery or endovascular intervention has been avoided.     

Massive Hemoptysis from Pulmonary Artery Pseudoaneurysm Caused by Lung Radiofrequency Ablation: Successful Treatment by Coil Embolization

A 75-year-old man received lung radiofrequency (RF) ablation to treat lung metastases from hepatocellular carcinoma. Massive hemoptysis occurred 1 week after lung RF ablation. Emergent contrast-enhanced CT and pulmonary arteriography revealed a pulmonary artery pseudoaneurysm, which was embolized with coils. The postembolization course was uneventful. Hemoptysis did not recur for 5 months.     

Pancreatitis-Associated Splenic Artery Pseudoaneurysm: Endovascular Treatment with Self-Expandable Stent-Grafts

We present a patient with a splenic artery pseudoaneurysm (SAPA) treated with placement of self-expandable stent-grafts. The procedure was complicated by stent-graft migration, but successful management resulted in lasting exclusion of the SAPA, while the patency of the splenic artery was preserved. This is the first report of self-expandable stent-graft treatment of SAPA.     

Endovascular Treatment of a Coronary Artery Bypass Graft to Pulmonary Artery Fistula with Coil Embolization

Fistula formation between a coronary artery bypass graft (CABG)and the pulmonary arterial circulation represents a rare cause of recurrent angina in patients following bypass grafting. Therapy has traditionally involved surgical ligation by open thoracotomy. We describe a case of left internal mammary artery–left upper lobe pulmonary artery fistula presenting as early recurrent angina following CABG. The fistula was embolized using platinum coils, resulting in symptomatic relief and improvement in myocardial perfusion on cardiac perfusion scintigraphy. Coil embolization should be considered a therapeutic option in patients with coronary–pulmonary steal syndrome.     

Modified Stent-Assisted Coil Embolization Technique to Treat an Internal Iliac Artery Aneurysm

Stent-assisted coil embolization is a well-described technique for the treatment of wide-necked intracranial aneurysms. We describe a modification of this technique used successfully to occlude a wide-necked internal iliac artery aneurysm.     

Coil Embolization Treatment in Pulmonary Artery Branch Rupture During Swan-Ganz Catheterization

Rupture of the pulmonary artery or one of its branches during Swan-Ganz catheterization is a complication that is rare but remains fatal in almost 50% of cases. The risk factors and mechanisms involved in the pathogenesis of this accident have been widely reported. Management is twofold: resuscitation procedures and specific medical or even surgical treatment. We report a case of pulmonary artery rupture occurring during Swan-Ganz catheterization that was treated by coil embolization. This technique, which is quick and simple to use, would appear to be very promising. This is the first case of successful emergency treatment of pulmonary artery rupture using an endovascular technique.     

Coil Embolization with Side-Holed Catheter to Preserve Peripheral Flow for Visceral Artery Pseudoaneurysm: An Experimental Study in Swine

PurposeTo evaluate the safety and efficacy of coil embolization with an indwelling catheter with side holes to control visceral artery bleeding while simultaneously preserving peripheral artery flow.Materials and MethodsA 6-F anticoagulant-coated catheter with two symmetrically arranged side holes was used with coil embolization to induce hemostasis in the superior mesenteric artery (SMA) of 13 pigs. The SMA was punctured with a metal needle to induce bleeding. The catheter was advanced into the SMA immediately after the puncture, and the midpoint between its tip and side holes was adjusted to conform to the puncture site. The SMA was embolized by using microcoils placed around the catheter to achieve hemostasis. Hemostasis and gross ischemic changes of the intestine were visually observed during the abdominal surgery. Peripheral blood flow was assessed by using abdominal aortography for as long as 2 hours in 13 pigs and was assessed again at 7 days in three pigs.ResultsAntegrade peripheral artery flow through the indwelling catheter was preserved without stagnation for as long as 2 hours in all 13 pigs and at 7 days in two of three pigs. One catheter occlusion was seen at the 7-day time point. There were no observable instances of recurrent bleeding, ischemic changes in the intestine, or vascular adverse events during or after the procedure.ConclusionsThe hemostatic method described here is a technically feasible method of controlling acute visceral artery bleeding while preserving peripheral artery flow and may be particularly useful in cases of absence of collateral circulation. Further experiments are warranted for clinical application.