Coil Migration after Transarterial Coil Embolization of a Splenic Artery Pseudoaneurysm

Tekola, Bezawit D.; Arner, David; Behm, Brian W.

doi:10.1159/000357151

Cited by 29 publications

(32 citation statements)

References 8 publications

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“…The decision appeared to be right as no splenic infarction was detected in a follow-up CT. Endovascular embolization seemed to be an inadequate therapeutic option because it might have not represented definitive management in a patient with pseudoaneurysm with GI bleeding, as there was by definition a fistulous connection. Beside, there have been several reports of post-procedural coil migration in such situations [10]. In patients with splenic artery pseudoaneurysm involving adjacent organs surgery should be considered as definitive treatment to eradicate the underlying etiology and reduce further morbidity.…”

Section: Discussionmentioning

confidence: 99%

Massive Upper Gastrointestinal Bleeding from a Splenic Artery Pseudoaneurysm Caused by a Penetrating Gastric Ulcer: Case Report and Review of Literature

et al. 2015

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SummaryBackgroundSplenic artery aneurysm and pseudoaneurysm are rare pathologies. True aneurysms are usually asymptomatic. Aneurysm rupture occurring in 2–3% of cases results in bleeding into the lesser sack, peritoneal space or adjacent organs typically presenting as abdominal pain and hemodynamic instability. In contrast, pseudoaneurysms are nearly always symptomatic carrying a high risk of rupture of 37–47% and mortality rate of 90% if untreated. Therefore, prompt diagnosis and treatment are essential in the management of patients with splenic artery pseudoaneurysm. Typical causes include pancreatitis and trauma. Rarely, the rupture of a pseudoaneurysm presents as upper gastrointestinal (UGI) bleeding. Among causes, peptic ulcer is the casuistic one.Case ReportThis report describes a very rare case of recurrent UGI bleeding from a splenic artery pseudoaneurysm caused by a penetrating gastric ulcer. After negative results of endoscopy and ultrasound, the diagnosis was established in CT angiography. The successful treatment consisted of surgical ligation of the bleeding vessel and suture of the ulcer with preservation of the spleen and pancreas, which is rarely tried in such situations.ConclusionsThe most important factor in identifying a ruptured splenic artery pseudoaneurysm as a source of GI bleeding is considering the diagnosis. UGI hemorrhage from splenic artery pseudoaneurysm can have a relapsing course providing false negative results of endoscopy and ultrasound if performed between episodes of active bleeding. In such cases, immediate CT angiography is useful in establishing diagnosis and in application of proper therapy before possible recurrence.

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Section: Discussionmentioning

confidence: 99%

Massive Upper Gastrointestinal Bleeding from a Splenic Artery Pseudoaneurysm Caused by a Penetrating Gastric Ulcer: Case Report and Review of Literature

et al. 2015

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“…Aneurysm coil migration from all sites into the gastrointestinal tract has been reported in at least twelve cases [ 25 , 26 ]. Coil migration into the CBD from the RHA has been reported in five cases (Table 1 ) [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Vascular coil erosion into hepaticojejunostomy following hepatic arterial embolisation

et al. 2015

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BackgroundRight hepatic arterial injury (RHAI) is the most common vascular injury sustained during laparoscopic cholecystectomy, occurring in up to 7% of cholecystectomies. RHAI is also the most common vascular injury associated with a bile duct injury (BDI) and is reported to occur in up to 41 – 61% of cases when routine angiography is employed following a BDI.We present an unusual case of erosion of vascular coils from a previously embolised right hepatic artery into bilio-enteric anastomoses causing biliary obstruction. This is on a background of biliary reconstruction following a major BDI.Case presentationA 37-year old man underwent a bile duct reconstruction following a major BDI (Strasberg-Bismuth E4 injury) sustained at laparoscopic cholecystectomy. He had two separate bilio-enteric anastomoses of the right and left hepatic ducts and had a modified Terblanche Roux-en-Y access limb formed.Approximately three weeks later he was admitted for significant gastrointestinal bleeding and was hypotensive and anaemic. Selective computed tomography angiography revealed a 2 x 2 centimetre right hepatic artery pseudoaneurysm, which was urgently embolised with radiological coils.Two months later he developed intermittent fevers, rigors, jaundice, and right upper quadrant pain with evidence of intrahepatic biliary dilatation on magnetic resonance cholangiopancreatography. The degree of intrahepatic biliary dilatation progressively increased on subsequent imaging over several months, suggesting stricturing of the bilio-enteric anastomoses. Several attempts to traverse these strictures with a percutaneous transhepatic approach had failed. Then, approximately ten months after the initial BDI repair, choledochoscopy through the Terblanche access limb revealed multiple radiological coils within the bilio-enteric anastomoses, which had eroded from the previously embolised right hepatic artery. A laparotomy was performed to remove the coils, take down the existing obstructed bilio-enteric anastomoses and revise this. Following this the patient recovered uneventfully.ConclusionObstructive jaundice and cholangitis secondary to erosion of angiographically placed embolisation coils is a rarely described complication. In view of the relative frequency of arterial injury and complications following major bile duct injury, we suggest that these patients be formally assessed for associated arterial injury following a major BDI.

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“…It has been hypothesized that surgical management of ruptured aneurysms and pseudoaneurysms of the SA usually consist of splenectomy or splenopancreatectomy; however, asymptomatic true aneurysms can be treated with splenopancreatic preservation [ 9 ]. Recently TAE has become increasing utilized in the management of such bleeds.…”

Section: Discussionmentioning

confidence: 99%

“…However, this may not represent adequate definitive management in a patient with an SA aneurysm or pseudoaneurysm with GI bleeding, as there is by definition a fistulus connection. It is unsurprising that there have been several reports of post procedural embolic coil migration [ 9 ]. We believe that the presence of an SA pseudoaneurysm with GI bleeding can initially be diagnosed and managed using angiography and TAE; however, definitive surgery to remove the underlying etiology must be strongly considered to reduce future morbidity in surgically acceptable candidates.…”

Section: Discussionmentioning

confidence: 99%

A benign gastric ulcer eroding into a splenic artery pseudoaneurysm presenting as a massive upper gastrointestinal bleed

Syed

Moradian²,

Ahmed

et al. 2014

Journal of Surgical Case Reports

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Upper gastrointestinal (UGI) bleeding secondary to a ruptured splenic artery (SA) pseudoaneurysm into the stomach is a rare but a life-threatening condition. Owing to the low prevalence, it remains a diagnostic and therapeutic challenge. A frail 77-year-old Caucasian female presented with epigastric pain and hematemesis. Endoscopy was non-diagnostic for an etiology. She then underwent diagnostic angiography that revealed an SA pseudoaneurysm with active contrast extravasation into the stomach. Subsequent transcatheter arterial coil embolization was conducted of the SA. The patient was subsequently taken for a partial gastrectomy, distal pancreatectomy and splenectomy. She had an uncomplicated postoperative course.Diagnosis of an UGI bleeding secondary to a ruptured SA pseudoaneurysm into the stomach remains difficult. However, we report that in a hemodynamically stable patient, a multidisciplinary approach can be taken, with interval optimization of the patient prior to definitive surgery for a satisfactory outcome.

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Coil Migration after Transarterial Coil Embolization of a Splenic Artery Pseudoaneurysm

Cited by 29 publications

References 8 publications

Massive Upper Gastrointestinal Bleeding from a Splenic Artery Pseudoaneurysm Caused by a Penetrating Gastric Ulcer: Case Report and Review of Literature

Massive Upper Gastrointestinal Bleeding from a Splenic Artery Pseudoaneurysm Caused by a Penetrating Gastric Ulcer: Case Report and Review of Literature

Vascular coil erosion into hepaticojejunostomy following hepatic arterial embolisation

A benign gastric ulcer eroding into a splenic artery pseudoaneurysm presenting as a massive upper gastrointestinal bleed

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