Strategies for the Endovascular Management of Visceral Artery Aneurysm and Pseudoaneurysm

Educational Poster Background: Visceral artery aneurysm (VAA) and visceral artery pseudoaneurysm (VAPA) rupture can lead to catastrophic hemorrhage with high mortality. Diagnosis is with computed tomographic angiogram. Management is endovascular and aims to exclude the aneurysm from the circulation. We describe the treatment of three patients (mean age 74) with asymptomatic and ruptured VAA/VAPA presenting to a University Teaching Hospital. Patient A –30 mm gastroepiploic aneurysm: Angiogram confirmed a tortuous GA arising from the gastroduodenal artery (GDA). This aneurysm was excluded from the circulation by placement of embolization coils in front and back door arteries with angiographic success maintained during 2 years' imaging follow-up. Patient B – Ruptured 11 mm SMA branch pseudoaneurysm: DSA confirmed SMA branch pseudoaneurysm, tight coeliac axis (CA) stenosis, and right hepatic artery replacement to the GDA. The pseudoaneurysmal SMA branch also perfused the CA territory retrogradely via the GDA. Arterial inflow to the pseudoaneurysm was a tiny vessel with a high angle to the SMA branch. Covered stentgraft placement in the pseudoaneurysm neck was used to exclude it from the circulation while maintaining retrograde perfusion of the CA via the SMA. Patient C – 9 mm ruptured GDA branch aneurysm: DSA demonstrated CA occlusion and a pseudoaneurysm with a narrow neck supplied by a tortuous submillimeter GDA branch. CA occlusion and tortuosity prevented stent-graft placement. Embolization of the pseudoaneurysm feeding vessel would have compromised retrograde CA perfusion. The pseudoaneurysm neck was cannulated with 0.021” microcatheter and 0.014” wire and embolized using Histacryl glue and lipiodol (2:1 ratio). Angiogram showed exclusion of the pseudoaneurysm and maintained retrograde (via GDA) CA perfusion. Conclusion: In this educational poster, we show how our optimal treatment of these three patients presenting to our institution was determined by the clinical scenario and locoregional arterial anatomy.

Publication History

Article published online:
26 April 2021