Management of pancreaticoduodenal artery aneurysms: results of superselective transcatheter embolization

OBJECTIVE: The purpose of our study was to assess the efficacy of transcatheter arterial embolization for pancreaticoduodenal artery aneurysms. CONCLUSION: We concluded that transcatheter arterial embolization is the initial and definitive therapeutic choice for pancreaticoduodenal artery aneurysms, with a possible option to perform surgery after embolization.     

Multiple pulmonary artery pseudoaneurysms: intrasaccular embolization

We report the case of a 32-year-old female presenting with two pulmonary artery false aneurysms of mycotic origin. Considering the natural history and potential complications, we treated the patient by intrasaccular embolization with steel coils. No complication occurred. Received 22 August 1995; Revision received 30 April 1996; Accepted 2 May 1996     

Percutaneous transcatheter embolization of deep visceral pseudoaneurysms]

The authors present their experience with the percutaneous embolization of 13 splanchnic aneurysms and pseudoaneurysms (2 pseudoaneurysms of gastroduodenal artery, 3 of the hepatic artery, 7 renal pseudoaneurysms, 1 aneurysm of the splenic artery). In 9 of 13 cases the lesions were iatrogenic. Embolizing devices and techniques are described. Percutaneous embolization was successful in 12 of 13 cases, and useless in 1 case of renal pseudoaneurysm. In the 12 successfully treated cases the lesions were still occluded in the follow-up period. Transcatheter percutaneous embolization is the elective treatment in splanchnic aneurysms and pseudoaneurysms; surgery must be performed only when embolization fails.     

Multiple small pseudoaneurysms complicating pancreatitis: angiographic diagnosis and transcatheter embolization

We report a case of retroperitoneal hemorrhage due to multiple, small pseudoaneurysms complicating a chronic alcoholic pancreatitis. Cross-sectional imaging with CT and US could not clearly depict these vascular lesions. Selective arteriography of the superior mesenteric and gastroduodenal arteries clearly showed the small pseudoaneurysms and definitive treatment was performed by transcatheter embolization using coils. Eight months after successful embolization, the patient is asymptomatic without any recurrent bleeding. Received: 18 June 1999; Revised: 13 October 1999; Accepted: 15 October 1999     

Vertebral artery trauma: transcatheter embolization

Injuries of the vertebral arteries in four patients were treated by transcatheter embolization. Embolotherapy was performed after incomplete or unsuccessful surgery in three of the patients and as a preventive measure in lieu of surgery in the fourth patient. All procedures were successful and without complications. An injured vertebral artery is usually extremely difficult to approach surgically, but because of extensive collateral blood supply it is usually expendable; therefore, it becomes an inviting target for management by interventional angiographic techniques. Embolotherapy of an injured vertebral artery is easier, faster, and safer than its surgical ligation and, therefore, decidedly superior. With few exceptions, embolotherapy should be considered the preferred method in the management of vertebral artery trauma.     

Percutaneous embolization of ruptured splanchnic artery pseudoaneurysms

The usefulness of emergent embolotherapy was evaluated in 17 patients with life-threatening hemorrhage from 18 ruptured splanchnic artery pseudoaneurysms. Complete hemostasis was obtained in 16 out of 17 patients by embolotherapy. Of the 12 initial embolization procedures with permanent embolic materials including stainless steel coils, microcoils, and Ivalon, complete cessation of bleeding was obtained in 11. On the other hand, 6 out of 9 initial embolization procedures with Gelfoam particles failed to halt bleeding, and additional embolization with permanent embolic materials was required. Emergent embolization with permanent embolic materials using superselective catheterization should be considered the initial treatment of choice for ruptured splanchnic artery pseudoaneurysms.     

Endovascular management of splenic artery aneurysms and pseudoaneurysms

Splenic artery aneurysms and pseudoaneurysms are being diagnosed with increasing frequency by modern imaging. The question of appropriate treatment—surgical or endovascular—arises more often. We review our experience and that of others as documented in the literature. The information available suggests that endovascular management of a splenic artery aneurysm or pseudoaneurysm offers a lower complication rate than surgery, but postprocedure imaging to ensure obliteration is recommended.     

Splenic artery aneurysms and pseudoaneurysms: clinical distinctions and CT appearances

OBJECTIVE: Aneurysms of the splenic artery are being diagnosed with greater frequency as incidental findings on cross-sectional imaging. Splenic artery pseudoaneurysms are even more rare than true aneurysms. This article reviews the clinical features and management of splenic artery aneurysms and pseudoaneurysms. A variety of cases are presented to show the range of CT appearances. CONCLUSION: Radiologists who identify either type of splenic artery lesion should recognize the clinical and pathophysiologic distinctions between these two forms of splenic vascular pathology and understand the differences in management.     

Endovascular treatment of visceral artery aneurysms and pseudoaneurysms: our experience

Purpose

The aim of this study was to analyse our 8 years of experience with endovascular treatment of visceral aneurysms and pseudoaneurysms.

Materials and methods

From January 2002 to September 2009, we used an endovascular approach to treat 30 patients (22 men, eight women) affected by aneurysm (n=18) or pseudoaneurysm (n=13) of the splenic (n=11), hepatic (n=6), renal (n=5), pancreaticoduodenal (n=3), left gastric (n=2), gastroduodenal (n=1), rectal (n=1) or middle colic (n=1) arteries and the coeliac axis (n=1). Of these, 26/31 were treated with metal coils, 3/31 with Cardiatis multilayer stent, 1/31 with a coated stent and 1/31 with coils and Amplatzer plug. Procedures were performed electively in 10/30 cases and during haemorrhage in 20/30 cases. Follow-up was performed clinically (cessation of bleeding) and at 1, 6 and 12 months by colour-Doppler ultrasound (CDUS) and computed tomography (CT) angiography.

Results

In 31/31 aneurysms and pseudoaneurysms we obtained immediate exclusion. In four patients with aneurysm and in four with pseudoaneurysm, parenchymal ischaemia occurred; one was treated with surgical splenectomy. One patient with pseudoaneurysm of the coeliac axis died 10 days later because of new bleeding. During follow-up, all aneurysms and pseudoaneurysms remained excluded.

Conclusions

Percutaneous treatment is effective and safe, with a small number of complications, especially when compared with traditional surgery.     

Pulmonary artery aneurysms and pseudoaneurysms in adults: findings at CT and radiography

OBJECTIVE: The purpose of this pictorial essay is to illustrate the radiologic manifestations of pulmonary artery aneurysms and pseudoaneurysms with emphasis on the findings on contrast-enhanced CT. CONCLUSION: Pulmonary artery aneurysms and pseudoaneurysms are uncommon. Most are caused by trauma, often iatrogenic, infection, and Beh?et's syndrome. Less common causes include pulmonary hypertension, congenital heart disease, neoplasms, and connective tissue disease. Recognition of pulmonary artery aneurysms and pseudoaneurysms is important because of the high morbidity and mortality rates of rupture.     

Renal aneurysms and pseudoaneurysms

Pseudoaneurysms and aneurysms are abnormal dilatations of the vessel lumen. Pseudoaneurysm is a perfused hematoma contained by the adventitia and perivascular tissues that is in communication with the lumen of an adjacent artery or vein. Aneurysm is a dilatation of the vessel lumen involving all three layers of the blood vessel wall. Renal artery aneurysms (RAA) are uncommon but the widespread use of cross-sectional imaging and incidental detection of RAA may result in an increasing number of cases diagnosed. Renal artery pseudoaneurysms are suspected in bleeding patients after penetrating renal trauma. Imaging plays a major role in the detection of renal pseudoaneurysms and aneurysms and diagnoses aneurysm rupture and active bleeding. Computed tomography (CT), magnetic resonance imaging, and digital subtraction angiography can characterize lesion size, shape, and location and identify other aneurysms and pseudoaneurysms, helping to narrow the differential diagnosis and to understand the vascular anatomy for guiding proper treatment. Endovascular treatments have contributed considerably in the management of renal pseudoaneurysms and aneurysms. The use of coil embolization or covered stent placement prevents the mortality and mobility of surgery. The article describes imaging features and the endovascular therapies to treat these vascular processes and their possible complications.     

Multimodal approach to endovascular treatment of visceral artery aneurysms and pseudoaneurysms

PURPOSE: To assess the feasibility and the effectiveness of endovascular treatment of visceral arteries aneurysms (VAAs) using a "multimodal approach". MATERIAL AND METHODS: Twenty-five patients (mean age 60.1 years) with 29 VAAs (13 splenic, 4 hepatic, 3 gastroduodenal, 6 renal, 2 pancreatic-duodenal, 1 superior mesenteric) were considered suitable for endovascular treatment; 8/29 were ruptured. Saccular aneurysms (9/29) were treated by sac embolization with coils (in 4 cases associated with cyanoacrylate or thrombin) with preservation of artery patency. Fusiform aneurysms (6/29), were treated by an "endovascular exclusion". In 10/29 cases, supplied by a terminal branch, we performed an embolization of the afferent artery, with coils and cyanoacrylate or thrombin. 2/29 cases were treated with a stent-graft and 2/29 cases with a percutaneous ultrasound-guided thrombin injection and coils embolization of the afferent artery. The follow-up was performed by ultrasonography and/or CT-angiography 1 week after the procedure and then after 1, 6, and 12 months and thereafter annually. RESULTS: In 29/29 cases we obtained an immediate exclusion. Two patient died for other reasons. Complication rate was 27.6% (7 spleen ischemia and 1 stent-graft occlusion). During the follow-up (range: 7 days-36 months, mean 18.7 months), we observed 3/29 (10.3%) cases of reperfusion in the first month, all treated successfully with a further endovascular procedure. Primary technical success was 89.7%; secondary technical success was 100%. CONCLUSION: Endovascular therapy can be considered a feasible and effective approach for VAAs with good primary and secondary success rates.     

Transcatheter coil embolization of large pulmonary artery pseudoaneurysms in a child

The authors report a case of a 5-year-old boy who initially presented with mastoiditis, underwent successful surgical treatment, and during the immediate postoperative period developed multiple, bilateral pulmonary artery pseudoaneurysms. The large size and multiplicity of the pseudoaneurysms precluded the patient from undergoing thoracic surgery. Successful endovascular coil and wire embolization was performed in a staged set of procedures with use of more than 30 m of wire and coils.     

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

PURPOSE: 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. METHOD: 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. RESULTS: 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. CONCLUSION: 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.