Endovascular management of visceral artery pseudoaneurysms: transcatheter coil embolization using the isolation technique.
OBJECTIVE
To describe our experiences with treatment of visceral artery pseudoaneurysms (VAPA) by transcatheter coil embolization using an isolation technique and to propose indications for treating VAPA with this method.


METHODS
We treated 37 patients with VAPA endovascularly: There were 15 pancreaticoduodenal arcade, 10 hepatic, 5 renal, 3 splenic, and 1 each left gastric, gastroepiploic, adrenal, and superior mesenteric artery pseudoaneurysms. Preprocedure computed tomography (CT) and/or angiographic studies confirmed the presence of VAPA in all 37 patients. Using the isolation technique, we embolized vessels at sites distal and proximal to the pseudoaneurysm.


RESULTS
Transcatheter coil embolization with the isolation technique was technically successful in 33 (89%) of 37 patients, and angiogram confirmed the complete disappearance of the VAPA in 32 patients. No major complications occurred during the procedures. In a patient with a pancreaticoduodenal arcade artery pseudoaneurysm, we were unable to control hemorrhage. In 30 of 32 patients who recovered after transcatheter coil embolization using the isolation technique, follow-up CT scan showed no flow in VAPA; they survived without rebleeding. Two of the 32 patients (6%) with confirmed complete disappearance of VAPA on angiogram and CT scan obtained the day after the procedure manifested rebleeding during follow-up.


CONCLUSIONS
Transcatheter coil embolization using the isolation technique is an effective alternative treatment in patients with VAPA. In combination with coil embolization, the isolation technique is particularly useful in patients whose pseudoaneurysms present surgical difficulties.
Ikeda
Osamu
O
Department of Diagnostic Radiology, Kumamoto University, Graduate School of Medical and Pharmaceutical Sciences, 1-1-1 Honjo, Kumamoto, Japan. osamu-3643ik@do9.enjoy.ne.jp
Nakasone
Yutaka
Y
Tamura
Yoshitaka
Y
Yamashita
Yasuyuki
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000628:therapy*; D000792:Angiography; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014781:Viscera / Q000098:blood supply*
D003287:Contrast Media