Inferior epigastric artery pseudoaneurysm: A complication of paracentesis

Abstract

Two patients had inferior epigastric artery pseudoaneurysms after therapeutic paracentesis for ascites caused by portal hypertension. The first patient, a 62-year-old man, had a two-week history of left lower quadrant pain, tenderness, and nonpulsatile mass after a paracentesis for ascites. A left inferior epigastric artery pseudoaneurysm measuring 10 cm in diameter and 20 cm in length was diagnosed by means of Duplex ultrasound and arteriography. The patient was treated with percutaneous embolization, with successful thrombosis of the pseudoaneurysm. The second patient, a 33-year-old woman, had a six-week history of left lower quadrant pain, tenderness, and nonpulsatile mass after a paracentesis for ascites. Computerized tomography and arteriography showed a left inferior epigastric artery pseudoaneurysm, measuring 7 cm in diameter and 9 cm in length. The patient was treated with percutaneous embolization with successful thrombosis of the pseudoaneurysm. Both patients were discharged in good condition 2 days after embolization. Inferior epigastric artery pseudoaneurysm is a complication of paracentesis, and percutaneous embolization may be preferable to surgical repair in patients with chronic liver failure and portal hypertension.

Emergency Endovascular Hemostatic Technique Using N-butyl Cyanoacrylate for Retroperitoneal Hematoma Caused by Inferior Epigastric Artery Injury after Undergoing Catheter Ablation for Atrial Fibrillation: A Case Report

“…[4][5][6] As far as we searched in MEDical Literature Analysis and Retrieval System Online (MEDLINE), 19 published reports of 56 iatrogenic IEA injuries treated by EVT were identified between January 1965 and July 2016 ( Table 1). [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] to avoid adherence of the catheter to the glue, and the catheter should be retrieved with aspiration after the injection.…”

Transcatheter Arterial Embolisation for Haemorrhage from the Inferior Epigastric Artery after Acupuncture: A Case Report

“…[4][5][6] When inferior epigastric arteries or preformed pseudoaneurysms are injured, a pulseless, tender, abdominal mass and significant change in haematocrit levels are commonly noted, suggesting vessel injury and haematoma. However, in most cases, specific signs indicative of bleeding are not observed and haematomas are commonly misdiagnosed because of non-specific abdominal pain.…”

Spontaneous inferior epigastric artery pseudoaneurysm

“…4,9,11,13,14 On US, hematomas exhibit variable echogenicity and internal complex echotexture but almost never demonstrate internal blood flow. 8 Typical color Doppler US findings of a pseudoaneurysm include a focal area of flow with a mixed swirling of red and blue colors changing from systole to diastole, and a jet between the vessel and the aneurysmal sac. [3][4][5]8,9,11 On spectral Doppler analysis a ''to and fro'' sign is characteristic of a pseudoaneurysm.…”

“…8 Typical color Doppler US findings of a pseudoaneurysm include a focal area of flow with a mixed swirling of red and blue colors changing from systole to diastole, and a jet between the vessel and the aneurysmal sac. [3][4][5]8,9,11 On spectral Doppler analysis a ''to and fro'' sign is characteristic of a pseudoaneurysm. 16,17 The blood flows into the pseudoaneurysm during systole when the pressure in the artery is higher than in the pseudoaneurysm sac and the flow is reversed in diastole when the pressure in the artery drops.…”