Imaging-Guided Percutaneous Puncture and Embolization of Visceral Pseudoaneurysms: Feasibility and Outcomes

Abstract

Visceral artery pseudoaneurysms (VAPAs) are the most frequently diagnosed pseudoaneurysms (PSAs). PSAs can be asymptomatic or symptomatic. The aim of our study was to evaluate the safety and effectiveness of percutaneous embolization of VAPAs performed on patients with an unfeasible trans-arterial approach. Fifteen patients with fifteen visceral PSAs, with a median dimension of 21 mm (IQR 20–24 mm), were retrospectively analyzed. No patients were suitable for trans-arterial catheterization and therefore a percutaneous approach was chosen. During percutaneous treatments, two embolic agents were used, either N-butyl cyanoacrylate (NBCA) (Glubran II, GEM Milan, Italy) mixed with Lipiodol (Lipiodol, Guerbet, France) or thrombin. The outcomes of this study were technical success, primary clinical success, and secondary clinical success. In our population the 15 PSA were located as follows: 2 in the left gastric artery, 1 in the right gastric artery, 3 in the right hepatic artery, 2 in a jejunal artery, 1 in left colic artery branch, 1 in a right colic artery branch, 1 in the gastroepiploic artery, 1 in the dorsal pancreatic artery, 1 in an ileocolic artery branch, 1 in an iliac artery branch, and 1 in a sigmoid artery branch. 80% of PSAs (12/15) were treated with a NBCA:lipiodol mixture and 20% of PSAs (3/15) were treated with thrombin. Technical, primary, and secondary clinical successes were obtained in 100% of the cases. No harmful or life-threatening complications were observed. Minor complications were registered in 26.6% (4/15) of the patients. Percutaneous embolization of visceral PSA is a safe and effective treatment and should be considered as an option when the endovascular approach is unsuccessful or unfeasible.

Pseudoaneurysms embolization with glue via percutaneous direct puncture: a multicenter experience on 54 patients

“…The largest series has been published by Del Corso et al [ 3 ] on 91 patients; however all PAs were superficial and located in the limbs, mainly involving the femoral artery. Instead Carriero et al [ 2 ] and Gorsi at al. [ 10 ] embolized abdominal visceral PAs by direct puncture using cyanoacrylate in 12 and 21 patients respectively, both obtaining 100% technical success.…”

Multiple Aneurysms or Pseudoaneurysms of the Gastroepiploic Artery: An Anecdotal Cause of Hemoperitoneum

“…Perforation of the lateral branch of the gastroduodenal artery during the interventional procedure has been reported [10]. When the endovascular pathway is complex due to vascular tortuosity with acute angles, percutaneous embolization with tomography or ultrasound guidance is another option [2,5,14]. Surgical management with laparotomies and hemorrhage control may be necessary, especially in cases where the distal circulation needs to be preserved or is at risk [1,13,15].…”

Percutaneous Imaging Guided Puncture and Embolization of Visceral Pseudoaneurysms

“…In the past, PSAs were almost exclusively treated through invasive surgical procedures. However, literature linked such interventions with higher morbidity and mortality rates, highlighting the need to explore efficient but less invasive procedures [8].…”