Percutaneous Imaging Guided Puncture and Embolization of Visceral Pseudoaneurysms

Abstract

Background: Visceral pseudoaneurysms (PSAs) are usually treated endovascularly. No official guidelines exist regarding the correct management when this management option fails. The aim of this study is to assess the efficacy and safety of percutaneous imaging guided puncture of visceral PSAs in patients where intra-arterial embolization was unsuccessful or unfeasible.

Methods: Five patients with visceral artery pseudoaneurysms (VAPAs) were enrolled in the study. The diagnosis was made using a 64-slice multi-detector computed tomography (MDCT) scanner and all patients were previously considered unsuitable for the procedure or underwent the procedure unsuccessfully; all patients had anemia with hemoglobin loss greater than 2 g/dL in the last 24 hours. A 22-gauge Chiba needle was used to get percutaneous access to the lesion, where N-butyl cyanoacrylate (NBCA) and lipiodol or coils and onyx were subsequently injected.

Results: Four patients received a mixture of NBCA and lipiodol in a 1:2 ratio (80%, n = 4), and only one participant received coils and onyx. Primary clinical success was 100% and embolization was not repeated in any cases. No life-threatening secondary conditions or major complications were observed throughout the follow-up period; in one patient an asymptomatic embolic agent migration was reported. Secondary clinical success was also obtained in the current study. None of the remaining four participants experienced re-bleeding episodes or any procedure-related problems.

Conclusions: Percutaneous embolization of visceral PSAs is a safe and effective treatment alternative that should be considered when the trans-arterial method cannot be used.