Objective. To evaluate the technical success, safety, and outcome of endovascular embolization procedure in management of visceral artery pseudoaneurysms. Materials and Methods. 46 patients were treated for 53 visceral pseudoaneurysms at our institution. Preliminary diagnostic workup in all cases was performed by contrast enhanced abdominal CT scan and/or duplex ultrasound. In all patients, embolization was performed as per the standard departmental protocol. For data collection, medical records and radiology reports of all patients were retrospectively reviewed. Technical success, safety, and outcome of the procedure were analyzed. Results. Out of 46 patients, 13 were females and 33 were males. Mean patient age was years and mean pseudoaneurysm size was ？mm. Technical success rate for endovascular visceral pseudoaneurysm coiling was 93.47% . Complication rate was 6.52% . Followup was done for a mean duration of months (0.5–69 months). Complete resolution of symptoms or improvement in clinical condition was seen in 36 patients (80%) out of those 45 in whom procedure was technically successful. Conclusion. Results of embolization of visceral artery pseudoaneurysms with coils at our center showed high success rate and good short term outcome. 1. Introduction Visceral arteries include arteries of the splanchnic circulation and the renal arteries [1]. The pseudoaneurysms of visceral arteries (VPAs) are uncommon and attributed to degeneration of the vessel wall mostly due to infections and adjacent inflammation, trauma, and iatrogenic causes [2]. Hemorrhage due to rupture of these pseudoaneurysms is a rare but often life threatening complication which manifests as intra-abdominal or retroperitoneal bleeding and requires emergency treatment [3, 4]. Using digital subtraction angiography the bleeding site can be evaluated followed by embolization of the bleeding vessel or pseudoaneurysm employing superselective catheterization technique [5, 6]. To the best of our knowledge there is no published data available from the developing world regarding clinical presentation, procedural results, and clinical outcome of endovascular management of visceral artery pseudoaneurysms. This study was hence carried out to present details of our initial experience with the procedure at a tertiary care hospital in a third world country. 2. Materials and Methods This cross-sectional study was carried out at radiology department of a tertiary care hospital in third world country. The study was performed in accordance with the declaration of World Medical Association Declaration of
References
[1]
M. Jana, S. Gamanagatti, A. Mukund, S. Paul, P. Gupta, and P. Garg, “Endovascular management in abdominal visceral arterial aneurysms: a pictorial essay,” World Journal of Radiology, vol. 283, pp. 182–187, 2011.
[2]
R. A. Jesinger, A. A. Thoreson, and R. Lamba, “Abdominal and pelvic aneurysms and pseudoaneurysms: imaging review with clinical, radiologic, and treatment correlation,” Radiographics, vol. 33, no. 3, pp. E71–E96, 2013.
[3]
D. Grotemeyer, M. Duran, E. Park et al., “Visceral artery aneurysms—follow-up of 23 patients with 31 aneurysms after surgical or interventional therapy,” Langenbeck's Archives of Surgery, vol. 394, no. 6, pp. 1093–1100, 2009.
[4]
H. G. Lee, J. S. Heo, S. H. Choi, and D. W. Choi, “Management of bleeding from pseudoaneurysms following pancreaticoduodenectomy,” World Journal of Gastroenterology, vol. 16, no. 10, pp. 1239–1244, 2010.
[5]
H. Sethi, P. Peddu, A. Prachalias et al., “Selective embolization for bleeding visceral artery pseudoaneurysms in patients with pancreatitis,” Hepatobiliary & Pancreatic Diseases International, vol. 9, no. 6, pp. 634–638, 2010.
[6]
O. Ikeda, Y. Tamura, Y. Nakasone, Y. Iryou, and Y. Yamashita, “Nonoperative management of unruptured visceral artery aneurysms: treatment by transcatheter coil embolization,” Journal of Vascular Surgery, vol. 47, no. 6, pp. 1212–1219, 2008.
[7]
R. Pulli, W. Dorigo, N. Troisi, G. Pratesi, A. A. Innocenti, and C. Pratesi, “Surgical treatment of visceral artery aneurysms: a 25-year experience,” Journal of Vascular Surgery, vol. 48, no. 2, pp. 334–342, 2008.
[8]
E. M. Marone, D. Mascia, A. Kahlberg, C. Brioschi, Y. Tshomba, and R. Chiesa, “Is open repair still the gold standard in visceral artery aneurysm management?” Annals of Vascular Surgery, vol. 25, no. 7, pp. 936–946, 2011.
[9]
G. T. Fankhauser, W. M. Stone, S. G. Naidu et al., “The minimally invasive management of visceral artery aneurysms and pseudoaneurysms,” Journal of Vascular Surgery, vol. 53, no. 4, pp. 966–970, 2011.
[10]
U. Sachdev, D. T. Baril, S. H. Ellozy et al., “Management of aneurysms involving branches of the celiac and superior mesenteric arteries: a comparison of surgical and endovascular therapy,” Journal of Vascular Surgery, vol. 44, no. 4, pp. 718–724, 2006.
[11]
A. M. Belli, G. Markose, and R. Morgan, “The role of interventional radiology in the management of abdominal visceral artery aneurysms,” CardioVascular and Interventional Radiology, vol. 35, no. 2, pp. 234–243, 2012.
[12]
X. Ding, J. Zhu, M. Zhu et al., “Therapeutic management of hemorrhage from visceral artery pseudoaneurysms after pancreatic surgery,” Journal of Gastrointestinal Surgery, vol. 15, no. 8, pp. 1417–1425, 2011.
[13]
M. Chadha and C. Ahuja, “Visceral artery aneurysms: diagnosis and percutaneous management,” Seminars in Interventional Radiology, vol. 26, no. 3, pp. 196–206, 2009.
[14]
O. Ikeda, Y. Nakasone, Y. Tamura, and Y. Yamashita, “Endovascular management of visceral artery pseudoaneurysms: transcatheter coil embolization using the isolation technique,” CardioVascular and Interventional Radiology, vol. 33, no. 6, pp. 1128–1134, 2010.
[15]
L. E. Francisco, L. C. Asunción, C. A. Antonio, R. C. Ricardo, R. P. Manuel, and M. H. Caridad, “Post-traumatic hepatic artery pseudoaneurysm treated with endovascular embolization and thrombin injection,” World Journal of Hepatology, vol. 2, pp. 87–90, 2010.
[16]
S. Spiliopoulos, T. Sabharwal, D. Karnabatidis et al., “Endovascular treatment of visceral aneurysms and pseudoaneurysms: long-term outcomes from a multicenter European study,” Cardiovascular and Interventional Radiology, vol. 35, no. 6, pp. 1315–1325, 2012.
[17]
K. Izaki, M. Yamaguchi, R. Kawasaki, T. Okada, K. Sugimura, and K. Sugimoto, “N-butyl cyanoacrylate embolization for pseudoaneurysms complicating pancreatitis or pancreatectomy,” Journal of Vascular and Interventional Radiology, vol. 22, no. 3, pp. 302–308, 2011.
[18]
J. R. A. Skipworth, C. Morkane, D. A. Raptis et al., “Coil migration—a rare complication of endovascular exclusion of visceral artery pseudoaneurysms and aneurysms,” Annals of the Royal College of Surgeons of England, vol. 93, no. 4, pp. 19–23, 2011.
[19]
F. Cochennec, C. V. Riga, E. Allaire et al., “Contemporary management of splanchnic and renal artery aneurysms: results of endovascular compared with open surgery from two European vascular centers,” European Journal of Vascular and Endovascular Surgery, vol. 42, no. 3, pp. 340–346, 2011.
[20]
G. Piffaretti, C. Lomazzi, G. Carrafiello, M. Tozzi, G. Mariscalco, and P. Castelli, “Visceral artery: management of 48 cases,” Journal of Cardiovascular Surgery, vol. 52, no. 4, pp. 557–565, 2011.
[21]
X. L. Zhu, C. F. Ni, Y. Z. Liu, Y. H. Jin, J. W. Zou, and L. Chen, “Treatment strategies and indications for interventional management of pseudoaneurysms,” Chinese Medical Journal, vol. 124, no. 12, pp. 1784–1789, 2011.
[22]
Y.-K. Huang, H.-C. Hsieh, F.-C. Tsai, S.-H. Chang, M.-S. Lu, and P.-J. Ko, “Visceral artery aneurysm: risk factor analysis and therapeutic opinion,” European Journal of Vascular and Endovascular Surgery, vol. 33, no. 3, pp. 293–301, 2007.
