Direct Percutaneous Puncture and Embolization of Visceral Pseudoaneurysm: Safety and Clinical Efficacy

Background: The aim of the study was to assess the safety and clinical efficacy of direct percutaneous puncture and embolization in the treatment of visceral pseudoaneurysm. Methods: Retrospective analysis of all patients undergoing direct percutaneous puncture of pseudoaneurysm and embolization between January 2012 and January 2017 was done. The study included 26 patients (19 male and 7 female) with a mean age of 36 years (range: 10–71 years). Indications for direct percutaneous embolization were difficult catheterization of feeding artery, previous embolization of proximal artery, and the inability to identify feeding artery on angiography. Patients' demography, details of endovascular procedure, complications, and clinical outcome were evaluated. Patients were followed up for the recurrence of pseudoaneurysm (mean follow-up was 12 months). Results: Etiologies were pancreatitis in 20 patients, trauma in 2 patients, iatrogenic in 2 patients, and incidentally detected in 2 patients. Twenty-three patients had difficult catheterization, two patients had prior embolization of feeding artery, and in one patient, feeding artery was not identifiable on angiography. N-butyl cyanoacrylate (NBCA) with lipiodol was used in 23 (88.4%) patients, coil was used in 1 (3.8%) patient, and both coil and NBCA were used in 2 (7.7%) patients. Embolization of pseudoaneurysm was successful in all cases. No procedure-related complications were seen. Follow-up showed no recurrence of pseudoaneurysm. Self-limiting splenic infarct was seen in six patients. Self-limiting abdominal pain was seen in all patients with NBCA embolization. One patient developed liver infarct and subsequent liver abscess requiring percutaneous drainage. Conclusion: Direct percutaneous puncture and embolization are safe and effective in the treatment of visceral pseudoaneurysms and can be considered as alternative in patients with failed endovascular approach.

Publication History

Article published online:
11 May 2021