Application of interventional embolization in the treatment of iatrogenic pseudoaneurysms

Xu,Hao; Jing,Cong; Zhou,Jie; Min,Xuli; Zhao,Jing; Yang,Lin; Ren,Yongjun

doi:10.3892/etm.2020.9378

Application of interventional embolization in the treatment of iatrogenic pseudoaneurysms

Authors:
- Hao Xu
- Cong Jing
- Jie Zhou
- Xuli Min
- Jing Zhao
- Lin Yang
- Yongjun Ren
View Affiliations

Affiliations: Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China, Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
Published online on: October 22, 2020 https://doi.org/10.3892/etm.2020.9378
Article Number: 248
Copyright: © Xu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The present study aimed to investigate the clinical effectiveness and safety of endovascular embolization for the treatment of pseudoaneurysm secondary to previous abdominal and pelvic surgery or radiological percutaneous abdominal procedure. A retrospective review was performed on all patients with abdominal and pelvic pseudoaneurysm confirmed by CT angiography or digital subtraction angiography and treated with endovascular embolization. Different techniques of embolization with coils were applied and the outcomes, including clinical effectiveness and safety, were assessed. A total of 31 patients with a total of 32 pseudoaneurysms were included in the present study. Of these pseudoaneurysms, 23 were from the main trunks and branches of the gastroduodenal artery, 5 were from the splenic artery, 2 were from the common hepatic artery, 1 was from the right hepatic artery and 1 was from the right internal iliac artery. There were no serious complications observed and there was no occurrence of re‑bleeding following embolization. The embolization of the pseudoaneurysms was successful in all patients. In conclusion, endovascular embolization is a safe and effective method for the treatment of secondary iatrogenic pseudoaneurysm in the abdomen and pelvis.

View Figures

View References

1	Luo J, Fu X, Zhou Y, Tang H, Song G, Tang T, Liao X and Zhou X: Aortic remodeling following Sun's procedure for acute Type A aortic dissection. Med Sci Monit. 23:2143–2150. 2017.PubMed/NCBI View Article : Google Scholar
2	Nosher JL, Chung J, Brevetti LS, Graham AM and Siegel RL: Visceral and renal artery aneurysms: A pictorial essay on endovascular therapy. Radiographics. 26:1687–1704. 2006.PubMed/NCBI View Article : Google Scholar
3	Yekebas EF, Wolfram L, Cataldegirmen G, Habermann CR, Bogoevski D, Koenig AM, Kaifi J, Schurr PG, Bubenheim M, Nolte-Ernsting C, et al: Postpancreatectomy hemorrhage: Diagnosis and treatment: An analysis in 1669 consecutive pancreatic resections. Ann Surg. 246:269–280. 2007.PubMed/NCBI View Article : Google Scholar
4	Chen X, Yuan D, Zhao J, Huang B and Yang Y: Hybrid repair for a complex infection aortic pseudoaneurysm with continued antibiotic therapy: A case report and literature review. Medicine (Baltimore). 98(e14330)2019.PubMed/NCBI View Article : Google Scholar
5	Madhusudhan KS, Venkatesh HA, Gamanagatti S, Garg P and Srivastava DN: Interventional radiology in the management of visceral artery pseudoaneurysms: A review of techniques and embolic materials. Korean J Radiol. 17:351–363. 2016.PubMed/NCBI View Article : Google Scholar
6	Martins A, Goncalves A, Passos P, Cardoso M, Torres R, Almeida T and Midões A: Splenic artery pseudoaneurysm. J Gastrointest Surg. 22:1297–1298. 2018.PubMed/NCBI View Article : Google Scholar
7	Rottoli M, Sabharwal T, Schizas AM and George ML: Bleeding pseudoaneurysm of the internal iliac artery after extended resection for advanced rectal cancer: Report of two cases. Int J Colorectal Dis. 29:1585–1586. 2014.PubMed/NCBI View Article : Google Scholar
8	Corvino A, Catalano O, de Magistris G, Corvino F, Giurazza F, Raffaella N and Vallone G: Usefulness of doppler techniques in the diagnosis of peripheral iatrogenic pseudoaneurysms secondary to minimally invasive interventional and surgical procedures: Imaging findings and diagnostic performance study. J Ultrasound: May 20, 2020 doi: 10.1007/s40477-020-00475-6 (Epub ahead of print).
9	Li Y, Liang W, Zhang J and Peng R: Association of difference in coronary sinus diameter by computed tomographic angiography between patients in and not in stable atherosclerotic plaque(S). Med Sci Monit. 24:3265–3273. 2018.PubMed/NCBI View Article : Google Scholar
10	Keeling AN, McGrath FP and Lee MJ: Interventional radiology in the diagnosis, management, and follow-up of pseudoaneurysms. Cardiovasc Intervent Radiol. 32:2–18. 2009.PubMed/NCBI View Article : Google Scholar
11	Saad NE, Saad WE, Davies MG, Waldman DL, Fultz PJ and Rubens DJ: Pseudoaneurysms and the role of minimally invasive techniques in their management. Radiographics. 25 (Suppl 1):S173–S189. 2005.PubMed/NCBI View Article : Google Scholar
12	Pitton MB, Dappa E, Jungmann F, Kloeckner R, Schotten S, Wirth GM, Mittler J, Lang H, Mildenberger P, Kreitner KF, et al: Visceral artery aneurysms: Incidence, management, and outcome analysis in a tertiary care center over one decade. Eur Radiol. 25:2004–2014. 2015.PubMed/NCBI View Article : Google Scholar
13	Dohan A, Eveno C, Dautry R, Guerrache Y, Camus M, Boudiaf M, Gayat E, Le Dref O, Sirol M and Soyer P: Role and effectiveness of percutaneous arterial embolization in hemodynamically unstable patients with ruptured splanchnic artery pseudoaneurysms. Cardiovasc Intervent Radiol. 38:862–870. 2015.PubMed/NCBI View Article : Google Scholar
14	Reiter DA, Fischman AM and Shy BD: Hepatic artery pseudoaneurysm rupture: A case report and review of the literature. J Emerg Med. 44:100–103. 2013.PubMed/NCBI View Article : Google Scholar
15	Thaut L, Weymouth W, Hunsaker B and Reschke D: Evluation of central venous access with accelerated seldinger technique versus modified seldinger technique. J Emerg Med. 56:23–28. 2019.PubMed/NCBI View Article : Google Scholar
16	Angle JF, Siddiqi NH, Wallace MJ, Kundu S, Stokes L, Wojak JC and Cardella JF: Society of Interventional Radiology Standards of Practice Committee: Quality improvement guidelines for percutaneous transcatheter embolization: Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol. 21:1479–1486. 2010.PubMed/NCBI View Article : Google Scholar
17	Hassold N, Wolfschmidt F, Dierks A, Klein I, Bley T and Kickuth R: Effectiveness and outcome of endovascular therapy for late-onset postpancreatectomy hemorrhage using covered stents and embolization. J Vas Surg. 64:1373–1383. 2016.PubMed/NCBI View Article : Google Scholar
18	Jabbour G, Al-Hassani A, El-Menyar A, Abdelrahman H, Peralta R, Ellabib M, Al-Jogol H, Asim M and Al-Thani H: Clinical and radiological presentations and management of blunt splenic trauma: A single tertiary hospital experience. Med Sci Monit. 23:3383–3392. 2017.PubMed/NCBI View Article : Google Scholar
19	Pan Z, Zhang H, Li L, Jia Y and Tian R: Surgical treatment of traumatic lower limb pseudoaneurysm. Chin J Traumatol. 17:285–288. 2014.PubMed/NCBI
20	Branchi V, Meyer C, Verrel F, Kania A, Bölke E, Semaan A, Koscielny A, Kalff JC and Matthaei H: Visceral artery aneurysms: Evolving interdisciplinary management and future role of the abdominal surgeon. Eur J Med Res. 241(17)2019.PubMed/NCBI View Article : Google Scholar
21	Gabelmann A, Gorich J and Merkle EM: Endovascular treatment of visceral artery aneurysms. J Endovasc Ther. 9:38–47. 2002.PubMed/NCBI View Article : Google Scholar
22	Feng J, Chen YL, Dong JH, Chen MY, Cai SW and Huang ZQ: Post-pancreaticoduodenectomy hemorrhage: Risk factors, managements and outcomes. Hepatobiliary Pancreat Dis Int. 13:513–522. 2014.PubMed/NCBI View Article : Google Scholar
23	Dumitru R, Carbunaru A, Grasu M, Toma M, Ionescu M and Dumitrascu T: Pseudoaneurysm of the splenic artery-an uncommon cause of delayed hemorrhage after pancreaticoduodenectomy. Ann Hepatobiliary Pancreat Surg. 20:204–210. 2016.PubMed/NCBI View Article : Google Scholar
24	Gao F, Li J, Quan S, Li F, Ma D, Yao L and Zhang P: Risk factors and treatment for hemorrhage after pancreaticoduodenectomy: A case series of 423 patients. Biomed Res Int. 2016(2815693)2016.PubMed/NCBI View Article : Google Scholar
25	Schafer M, Heinrich S, Pfammatter T and Clavien PA: Management of delayed major visceral arterial bleeding after pancreatic surgery. HPB (Oxford). 13:132–138. 2011.PubMed/NCBI View Article : Google Scholar
26	Jesinger RA, Thoreson AA and Lamba R: Abdominal and pelvic aneurysms and pseudoaneurysms: Imaging review with clinical, radiologic, and treatment correlation. Radiographics. 33:E71–E96. 2013.PubMed/NCBI View Article : Google Scholar
27	Dohan A, Dautry R, Guerrache Y, Fargeaudou Y, Boudiaf M, Le Dref O, Sirol M and Soyer P: Three-dimensional MDCT angiography of splanchnic arteries: Pearls and pitfalls. Diagn Interv Imaging. 96:187–200. 2015.PubMed/NCBI View Article : Google Scholar
28	Balderi A, Antonietti A, Ferro L, Peano E, Pedrazzini F, Fonio P and Grosso M: Endovascular treatment of visceral artery aneurysms and pseudoaneurysms: Our experience. Radiol Med. 117:815–830. 2012.PubMed/NCBI View Article : Google Scholar
29	Vander Mijnsbrugge W, Laleman W, Van Steenbergen W, Heye S, Verslype C and Maleux G: Long-term clinical and radiological outcoome of endovascular embolization of pancreatitis-related pseudoaneurysms. Acta Radiol. 58:316–322. 2017.PubMed/NCBI View Article : Google Scholar
30	You Y, Choi SH, Choi DW, Heo JS, Han IW, Han S, Shin SW, Park KB, Park HS, Cho SK and Han SH: Long-term clinical outcomes after endovascular management of ruptured pseudoaneurysm in patients undergoing pancreaticoduodenectomy. Ann Surg Treat Res. 96:237–249. 2019.PubMed/NCBI View Article : Google Scholar
31	Xu H, Jing C, Zhou J, Min X, Zhao J, Yang L and Ren Y: Clinical efficacy of coil embolization in treating pseudoaneurysm post-Whipple operation. Exp Ther Med. 20(37)2020.PubMed/NCBI View Article : Google Scholar
32	Zhao Q, Xu H, Min X, Yang L and Ren Y: Imaging features of vertebral aneurysmal bone cyst and the clinical value of interventional embolization. Exp Ther Med. 20:3832–3836. 2020.PubMed/NCBI View Article : Google Scholar
33	Liao X, Xu H, Liu F, Min X, Li Y, Yang L and Ren Y: Value of angioembolization in the treatment of iatrogenic renal vascular injury assisted by 3-dimensional digital subtraction angiography. Med Sci Monit. 26(e927208)2020.PubMed/NCBI View Article : Google Scholar
34	Xu H, Min X, Li Y, Yang L and Ren Y: A comparative study of conservation, endovascular embolization therapy, and surgery for blunt renal trauma. Med Sci Monit. 26(e922802)2020.PubMed/NCBI View Article : Google Scholar
35	Wang D, Su L, Han Y and Fan X: Embolization treatment of pseudoaneurysms originating from the external carotid artery. J Vasc Surg. 61:920–926. 2015.PubMed/NCBI View Article : Google Scholar
36	Giurazza F, Corvino F, Cavaglià E, Silvestre M, Cangiano G, Amodio F, De Magistris G and Niola R: Emborrhoid in patients with portal hypertension and chronic hemorrhoidal bleeding: Preliminary results in five cases with a new coiling release fashion ‘Spaghetti technique’. Radiol Med. 125:1008–1011. 2020.PubMed/NCBI View Article : Google Scholar
37	Sueyoshi E, Sakamoto I, Nakashima K, Minami K and Hayashi K: Visceral and peripheral arterial pseudoaneurysms. AJR Am J Roentgenol. 185:741–749. 2005.PubMed/NCBI View Article : Google Scholar
38	Lwin TM, Leigh N, Iskandar ME, Steele JG, Wayne MG and Cooperman AM: Rare, uncommon, and unusual complications after pancreaticoduodenal resection. Surg Clin North Am. 98:87–94. 2018.PubMed/NCBI View Article : Google Scholar
39	Jesinger RA, Thoreson AA and Lamba R: Abdominal and pelvic aneurysms and pseudoaneurysms: Imaging review with clinical, radiologic, and treatment correlation. Radiographics. 33:E71–E96. 2013.PubMed/NCBI View Article : Google Scholar
40	Madhusudhan KS, Gamanagatti S, Garg P, Shalimar Dash NR, Pal S, Peush S and Gupta AK: Endovascular embolization of visceral artery pseudoaneurysms using modified injection technique with N-Butyl cyanoacrylate glue. J Vasc Interv Radiol. 26:1718–1725. 2015.PubMed/NCBI View Article : Google Scholar
41	Leyon JJ, Littlehales T, Rangarajan B, Hoey ET and Ganeshan A: Endovascular embolization: Review of currently available embolization agents. Curr Probl Diagn Radiol. 43:35–53. 2014.PubMed/NCBI View Article : Google Scholar