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CardioVascular and Interventional Radiology

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01-08-2015 | Clinical Investigation

Role and Effectiveness of Percutaneous Arterial Embolization in Hemodynamically Unstable Patients with Ruptured Splanchnic Artery Pseudoaneurysms

Authors: Anthony Dohan, Clarisse Eveno, Raphael Dautry, Youcef Guerrache, Marine Camus, Mourad Boudiaf, Etienne Gayat, Olivier Le Dref, Marc Sirol, Philippe Soyer

Published in: CardioVascular and Interventional Radiology | Issue 4/2015

Abstract

Purpose

To assess the role and effectiveness of percutaneous arterial embolization (TAE) in patients with hemodynamic instability due to hypovolemic shock secondary to ruptured splanchnic artery pseudoaneurysms (SAPA).

Materials and Methods

Seventeen patients (11 men, 6 women; mean age, 53 years) with hemodynamic instability (systolic blood pressure <90 mmHg) due to hypovolemic shock secondary to ruptured SAPA were treated by TAE. Clinical files, multidetector row computed tomography angiography, and angiographic examinations along with procedure details were reviewed.

Results

Seventeen SAPAs were present, predominantly located on gastroduodenal or pancreatic arteries (9/17; 53 %). Angiography showed extravasation of contrast medium from SAPA in 15/17 patients (88 %). Technical success rate of TAE was 100 %. TAE was performed using metallic coils in all patients (100 %), in association with gelatin sponge in 5/17 patients (29 %). TAE allowed controlling the bleeding and returning to normal hemodynamic status in 16/17 patients (94 %). In 1/17 patient (6 %), surgery was needed to definitively control the bleeding. The mortality and morbidity rate of TAE at 30 days were 0 and 12 %, respectively. Morbidity consisted in coil migration in 1/17 patient (6 %) and transient serum liver enzyme elevation in 1/17 patient (6 %).

Conclusion

TAE is an effective and safe treatment option for ruptured SAPA in hemodynamically unstable patients, with a success rate of 94 %. Our results suggest that TAE should be the favored option in patients with hemodynamic instability due to ruptured SAPA.

Saad NE, Saad WE, Davies MG, Waldman DL, Fultz PJ, Rubens DJ (2005) Pseudoaneurysms and the role of minimally invasive techniques in their management. Radiographics 25:S173–S189PubMedCrossRef

Ward WH, Platz TA, Pond KT, Southern FA, Moore EM (2009) Iatrogenic venous pseudoaneurysm: case report and review of the literature. Vascular 17:355–358PubMedCrossRef

Dohan A, Soyer P, Subhani A, Hequet D, Fargeaudou Y, Morel O, Boudiaf M, Gayat E, Barranger E, Le Dref O, Sirol M (2013) Postpartum hemorrhage resulting from pelvic pseudoaneurysm: a retrospective analysis of 588 consecutive cases treated by arterial embolization. Cardiovasc Interv Radiol 36:1247–1255CrossRef

Soyer P, Fargeaudou Y, Morel O, Boudiaf M, Le Dref O, Rymer R (2008) Severe postpartum haemorrhage from ruptured pseudoaneurysm: successful treatment with transcatheter arterial embolization. Eur Radiol 18:1181–1187PubMedCrossRef

Cordova AC, Sumpio BE (2013) Visceral artery aneurysms and pseudoaneurysms—should they all be managed by endovascular techniques? Ann Vasc Dis 6:687–693PubMedCentralPubMedCrossRef

Mokrane FZ, Alba CG, Lebbadi M, Mejdoubi M, Moulabbi M, Lombard F et al (2013) Pseudoaneurism of the cystic artery treated with hyperselective embolisation alone. Diagn Interv Imaging 94:641–643PubMedCrossRef

Boudghene F, L’Hermine C, Bigot JM (1993) Arterial complications of pancreatitis: diagnosis and therapeutic aspects in 104 cases. J Vasc Interv Radiol 4:551–558PubMedCrossRef

Tessier DJ, Stone WM, Fowl RJ, Abbas MA, Andrews JC, Bower TC, Gloviczki P (2003) Clinical features and management of splenic artery pseudoaneurysm: case series and cumulative review of literature. J Vasc Surg 38:969–974PubMedCrossRef

Agrawal GA, Johnson PT, Fishman EK (2007) Splenic artery aneurysms and pseudoaneurysms: clinical distinctions and CT appearances. AJR Am J Roentgenol 188:992–999PubMedCrossRef

10.

Marshall GT, Howell DA, Hansen BL, Amberson SM, Abourjaily GS, Bredenberg CE (1996) Multidisciplinary approach to pseudoaneurysms complicating pancreatic pseudocysts. Impact of pretreatment diagnosis. Arch Surg 131:278–283PubMedCrossRef

11.

Ferrero E, Ferri M, Viazzo A, Robaldo A, Carbonatto P, Pecchio A, Chiecchio A, Nessi F (2011) Visceral artery aneurysms, an experience on 32 cases in a single center: treatment from surgery to multilayer stent. Ann Vasc Surg 25:923–935PubMedCrossRef

12.

Tulsyan N, Kashyap VS, Greenberg RK, Sarac TP, Clair DG, Pierce G, Ouriel K (2007) The endovascular management of visceral artery aneurysms and pseudoaneurysms. J Vasc Surg 45:276–283PubMedCrossRef

13.

Udd M, Leppäniemi AK, Bidel S, Keto P, Roth WD, Haapiainen RK (2007) Treatment of bleeding pseudoaneurysms in patients with chronic pancreatitis. World J Surg 31:504–510PubMedCrossRef

14.

Song HH, Won YD, Kim YJ (2010) Transcatheter N-butyl cyanoacrylate embolization of pseudoaneurysms. J Vasc Interv Radiol 21:1508–1511PubMedCrossRef

15.

Cazejust J, Raynal M, Bessoud B, Tubiana JM, Menu Y (2012) Diagnosis and radiological treatment of digestive haemorrhage following supramesocolic surgery. Diagn Interv Imaging 93:e148–e158PubMedCrossRef

16.

Bergert H, Hinterseher I, Kersting S, Leonhoadt J, Bloomenthel A, Saeger HD et al (2005) Management and outcome of haemorrhage due to arterial pseudoaneurysms in pancreatitis. Surgery 137:323–328PubMedCrossRef

17.

Lau KY, Wong TP, Wong WW, Chan JK, Kan WK, Chan YF, Lee AS (2005) Transcatheter embolisation of visceral pseudoaneurysms—technical difficulties and modification of embolisation technique. Eur J Vasc Endovasc Surg 30:133–136PubMedCrossRef

18.

Loffroy R, Rao P, Ota S, De Lin M, Kwak BK, Krause D, Geschwind JF (2010) Packing technique for endovascular coil embolisation of peripheral arterial pseudo-aneurysms with preservation of the parent artery: safety, efficacy and outcomes. Eur J Vasc Endovasc Surg 40:209–215PubMedCrossRef

19.

Soyer P, Desgrippes A, Vallée JN, Rymer R (2000) Intrarenal pseudoaneurysm after percutaneous nephrostolithotomy: endovascular treatment with N-butyl-2-cyanoacrylate. Eur Radiol 10:1358PubMedCrossRef

20.

Tinto HR, Di Primio M, Tselikas L, Rico AP, Pellerin O, Pagny JY, Sapoval M (2014) Selective arterial embolization of life-threatening renal hemorrhage in four patients after partial nephrectomy. Diagn Interv Imaging. doi:10.1016/j.diii.2014.02.005 PubMed

21.

Goupil J, Fohlen A, Linard M, Vinatier L, Cuillier F, Collignon B, Storey J (2010) Ruptured uterine artery pseudo-aneurysm treated by embolization for post-partum bleeding: about 2 cases. J Gynecol Obstet Biol Reprod 39:325–330CrossRef

22.

Butori N, Coulange L, Filipuzzi L, Krausé D, Loffroy R (2009) Pseudoaneurysm of the uterine artery after cesarean delivery: management with superselective arterial embolization. Obstet Gynecol 113:540–543PubMedCrossRef

23.

Kobayashi L, Costantini TW, Coimbra R (2012) Hypovolemic shock resuscitation. Surg Clin North Am 92:1403–1423PubMedCrossRef

24.

Horton KM, Fishman EK (2003) Multidetector row and 3D CT of the mesenteric vasculature: normal anatomy and pathology. Semin Ultrasound CT MR 24:353–363PubMedCrossRef

25.

Liu PS, Platt JF (2014) CT angiography in the abdomen: a pictorial review and update. Abdom Imaging 39:196–214PubMedCrossRef

26.

Vimalraj V, Kannan DG, Sukumar R, Rajendran S, Jeswanth S, Jyotibasu D, Ravichandran P, Balachandar TG, Surendran R (2009) Haemosuccus pancreaticus: diagnostic and therapeutic challenges. HPB (Oxford) 11:345–350CrossRef

27.

Dohan A, Dautry R, Le Dref O, Soyer P (2014) Avoiding radiation in management of post-partum hemorrhage: CT angiography is not a good idea. Eur J Obstet Gynecol Reprod Biol. doi:10.1016/j.ejogrb.2014.03.022 PubMed

28.

Pilleul F, Forest J, Beuf O (2006) Magnetic resonance angiography of splanchnic artery aneurysms and pseudoaneurysms. J Radiol 87:127–1231PubMedCrossRef

29.

Chadha M, Ahuja C (2009) Visceral artery aneurysms: diagnosis and percutaneous management. Semin Interv Radiol 26:196–206CrossRef

30.

Fargeaudou Y, Le Dref O, Soyer P, Rao P, Boudiaf M, Sirol M, Dahan H, Hamzi L, Rymer R (2009) Life-threatening intra-abdominal hemorrhage from left superior colonic artery pseudoaneurysm after percutaneous renal biopsy: successful treatment with superselective arterial embolization. Clin Imaging 33:474–477PubMedCrossRef

31.

Yamakado K, Nakatsuka A, Tanaka N, Takano K, Matsumura K, Takeda K (2000) Transcatheter arterial embolization of ruptured pseudoaneurysms with coils and n-butyl cyanoacrylate. J Vasc Interv Radiol 11:66–72PubMedCrossRef

32.

Vainas T, Klompenhouwer E, Duijm L, Tielbeek X, Teijink J (2012) Endovascular treatment of a hepatic artery pseudoaneurysm associated with gastrointestinal tract bleeding. J Vasc Surg 55:1145–1149PubMedCrossRef

Title: Role and Effectiveness of Percutaneous Arterial Embolization in Hemodynamically Unstable Patients with Ruptured Splanchnic Artery Pseudoaneurysms
Authors: Anthony Dohan
Clarisse Eveno
Raphael Dautry
Youcef Guerrache
Marine Camus
Mourad Boudiaf
Etienne Gayat
Olivier Le Dref
Marc Sirol
Philippe Soyer
Publication date: 01-08-2015
Publisher: Springer US
Published in: CardioVascular and Interventional Radiology / Issue 4/2015
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-014-1002-2

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Role and Effectiveness of Percutaneous Arterial Embolization in Hemodynamically Unstable Patients with Ruptured Splanchnic Artery Pseudoaneurysms

Abstract

Purpose

Materials and Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Materials and Methods

Results

Conclusion

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