Percutaneous Embolization of an Inferior Mesenteric Artery Aneurysm in a Patient With Type IV Ehlers-Danlos Syndrome

Abstract

Ehlers-Danlos syndrome (EDS) refers to a group of genetic disorders involving the connective tissues. Type IV EDS impairs type III collagen that is responsible for vessel integrity. Patients with type IV EDS are susceptible to vascular and visceral complications, including aortic aneurysms, pseudoaneurysms, dissections, and spontaneous rupture of internal organs. Treating aneurysms with open surgery versus endovascular techniques each carry a unique risk-to-benefit ratio that must be applied to each individual carefully. We present a patient with type IV EDS who presented with a rapidly growing inferior mesenteric artery aneurysm. The patient was treated with a percutaneous endovascular technique using coils and n-butyl-cyanoacrylate glue.

The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms

“…Inferior mesenteric artery aneurysms are rare and are sparsely reported in the literature [172][173][174] ; they have been described in patients with collagen vascular disease or…”

Successful surgical management of a suspected high-flow inferior mesenteric artery aneurysm in a patient with chronic celiac and superior mesenteric artery occlusions

“… 9 Reported endovascular repairs have included chimney graft repairs (when a concomitant infrarenal AAA also exists) 17 and coil embolization. 18 , 19 Repair is likely warranted for nearly all IMA aneurysms because IMA rupture has been reported in aneurysms as small as 1 cm. 18 , 20 , 21 , 22 Massive gastrointestinal bleeding secondary to bowel fistulization has also been reported.…”

Successful Prophylactic Endovascular Therapy for a Rapidly Expanding Hepatic Arterial Aneurysm in a Patient with Vascular Ehlers–Danlos Syndrome

“…Coils have been employed in most of the reported cases in the small number of currently available publications. [8][9][10] In some reported cases, 8,9) N-butyl 2-cyanoacrylate (NBCA) was used along with coils. How- ever, microcatheter adhesion can occur, and therefore, indications for their use should be thoroughly considered before this procedure.…”