Interventional radiology in the diagnosis, management, and follow-up of pseudoaneurysms. Cardiovasc Intervent Radiol. 2009;32:2-18. [PMID: 18923864 DOI: 10.1007/s00270-008-9440-3]

Coil embolization of a palatine artery pseudoaneurysm in a gelding

OBJECTIVE

To describe successful transarterial coil embolization of a palatine artery pseudoaneurysm that extended into the caudal maxillary sinus of a gelding.

STUDY DESIGN

Clinical report.

ANIMAL

A 24-year-old Morgan gelding with right-sided epistaxis.

METHODS

The right maxillary sinus was imaged by radiography, computed tomography, and sinoscopy. Angiography was performed to locate the source of bleeding, and transarterial coil embolization of a right palatine artery pseudoaneurysm was performed.

RESULTS

There was some mucoid nasal discharge and an intermittent cough postoperatively. No epistaxis was seen after embolization. There was moderate swelling of the surgical incision over the mid-cervical common carotid artery. The horse was discharged from the hospital 4 days after surgery, and had been doing well, with no signs of bleeding, for 2 months postoperatively. The horse had acute colic secondary to a strangulating lipoma at 2 months and was euthanatized after exploratory celiotomy. Placement of embolization coils in the right palatine artery was confirmed by CT and necropsy.

CONCLUSIONS

Severe epistaxis in the horse may be caused by a ruptured major palatine artery pseudoaneurysm. Occlusion of this vessel can be successfully accomplished by transarterial coil embolization.

Endovascular coil embolization of a costocervical trunk pseudoaneurysm after bullectomy with pleural abrasion

Transarterial embolization (TAE) is less invasive than surgery for the treatment of pseudoaneurysms. Costocervical trunk (CCT) pseudoaneurysms are extremely rare. We herein report an unusual case of a 45-year-old man with a CCT pseudoaneurysm caused by a bullectomy with pleural abrasion, which had been performed to manage a spontaneous pneumothorax. The patient presented with chronic chest pain and successfully underwent TAE with a metallic coil. The chest pain completely disappeared 2 weeks after the TAE, and follow-up computed tomography showed that the pseudoaneurysm had almost completely disappeared 9 months after the TAE.

Miscellaneous pharmaceutical agents in interventional radiology

Interventional radiologists employ a wide variety of drugs on a daily basis to improve patient experiences and outcomes during interventional procedures. The expectation is for the interventionalist to be well-versed in all pharmaceuticals used in the interventional suite. In this article, the authors review the following classes of common miscellaneous pharmaceutical agents used in interventional radiology: vasodilators, vasoconstrictors, antiemetics, bowel antiperistalsis agents, and prothrombotics.

Emergency bedside sonographic diagnosis of subclavian artery pseudoaneurysm with brachial plexopathy after clavicle fracture

Clavicle fractures are common; however, complications are unusual. Two such complications, subclavian artery pseudoaneurysm and brachial plexopathy, are rare events that can cause significant morbidity and mortality. We report the case of a 53-year-old man who presented with shoulder swelling and right arm weakness for 1 week. Three weeks before, he had fallen and fractured his right clavicle. On presentation to our emergency department, his examination revealed a brachial plexopathy and a large supraclavicular mass. An emergency bedside triplex sonogram was performed to characterize the mass and revealed a swirling pattern within a fluid collection anterior to the subclavian artery, suggestive of a pseudoaneurysm. After computed tomography-angiography, the patient was taken to the operating room, where he underwent hematoma washout and subclavian artery stent-graft placement. This case illustrates how bedside point-of-care sonography can rapidly assist in the initial assessment of subclavian artery injury.

Cases of common carotid artery pseudoaneurysm treated by stent graft

Common carotid artery (CCA) pseudoaneurysms are rare and potentially lethal, and adequate treatment is warranted in order to prevent rupture or neurologic sequelae. The causes of CCA pseudoaneurysm include blunt or penetrating trauma, infection, and vasculitis, as well as iatrogenic and unknown causes. Previously, surgery was the standard treatment for pseudoaneurysm. However, endovascular surgical approaches such as stent graft or coiling have become effective alternatives with minimal morbidity and high success rates. Here, we report two cases of CCA pseudoaneurysms that were successfully treated by stent graft and review the current literature.

The use of balloon-expandable stent grafts for the management of acute arterial bleeding

PURPOSE

To evaluate the efficacy and safety of balloon-expandable stent grafts in the emergency treatment of acute arterial hemorrhage.

MATERIALS AND METHODS

Between July 2008 and December 2009, 15 patients with acute arterial hemorrhage from inflammatory vessel erosion or pseudoaneurysms (n = 9), noninflammatory pseudoaneurysms (n = 3), or iatrogenic vessel injury (n = 3) were treated with emergency stent graft implants. The primary study endpoints to determine treatment efficacy and safety were survival, complication rates, and freedom from recurrent hemorrhaging or reintervention. The secondary study endpoints were technical and clinical success.

RESULTS

The survival rate was 73% with a mean follow-up of 119 days ± 220. The complication rate was 20%. The procedure was technically successful in 13 of 15 (87%) patients. One endoleak persisted and led to a reintervention rate of 7%. The bleeding ceased immediately after stent graft implantation in 14 patients.

CONCLUSIONS

Implantation of balloon-expandable stent grafts is a safe and effective emergency treatment for acute arterial hemorrhage from visceral and peripheral vessels.

The diagnosis and endovascular management of superior mesenteric artery (SMA) branch pseudoaneurysms after appendicectomy

Pseudoaneurysms arising from the visceral arteries are rare. We present 2 patients who developed pseudoaneurysms arising from branches of the superior mesenteric artery (SMA) following laparoscopic appendicectomy. Both cases were successfully treated by endovascular embolization. The diagnosis and management of SMA branch pseudoaneurysms are discussed.

Embolisation of posttraumatic superior mesenteric artery pseudoaneurysm in a patient with short bowel syndrome preceding bowel transplantation

Penetrating abdominal trauma often causes bowel injuries which may lead to "short bowel syndrome" which is a potential indication for bowel transplantation. Posttraumatic pseudoaneurysms of abdominal arteries are often a result of penetrating abdominal trauma. We report a successful embolisation of posttraumatic superior mesenteric artery (SMA) branch pseudoaneurysm using microcoil, in a patient with short bowel syndrome who was successfully transplanted three months after embolisation.

Angioembolisation of pulmonary artery pseudoaneurysm arising in H1N1 influenza viral pneumonia

A 51 year-old Aboriginal woman was diagnosed with H1N1 influenza virus and methicillin-resistant Staphylococcus aureus. Contrasted CT of the pulmonary and bronchial vasculature undertaken for investigation for of haemoptysis revealed an 11 mm left upper lobe pulmonary artery pseudoaneurysm (PAP). The PAP was successfully treated with angioembolisation of the parent artery with two platinum coils. Pulmonary artery pseudoaneurysms are uncommon but potentially life-threatening and have not previously been reported in association with H1N1 influenza viral pneumonia, which has been prominent in recent times in both medical literature and popular press.

Unusual locations of pseudo aneurysms as a sequel of chronic pancreatitis

In patients with chronic pancreatitis, an actively bleeding pseudo aneurysm can be life threatening. Common sites of pseudoaneurysms are splenic, gastro-duodenal, superior & inferior pancreaticoduodenal arterial branches. Angioembolisation is an effective alternative to a complex and morbid operative management. Here we report 4 cases of unusual sites of pseudoaneurysms as a complication of pancreatitis, involving superior mesenteric and inferior phrenic arteries. Successful angioembolisation using glue and coil was achieved in 3 patients where as one underwent surgery. Technical success was 100% with the combination approach, though one patient died from multiorgan failure. This short case series reiterates the importance of vascular complications in pancreatitis at rare sites and also timely combined radiological and surgical approach for ensuring favorable outcome.

Inferior thyroid artery pseudoaneurysm caused by blunt trauma

Injury to the inferior thyroid artery (ITA) is an extremely rare complication of blunt neck trauma. The subtle initial clinical presentation and the potential life-threatening sequelae make it a diagnostic and therapeutic challenge. We report a case of an ITA pseudoaneurysm caused by seat-belt injury. Imaging findings and successful treatment with coil embolization are described. The role of noninvasive imaging techniques in establishing the diagnosis is emphasized.