Clinical application of medical adhesive in endovascular embolization treatment of peripheral pseudoaneurysm

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Abstract

Objectives:

This study explores the clinical application value of medical adhesive in endovascular embolization treatment of peripheral pseudoaneurysm.

Material and Methods:

This was a retrospective review on 31 patients with peripheral pseudoaneurysm treated with medical adhesive endovascular embolization at the First Affiliated Hospital of Shihezi University from July 2021 to July 2023. Follow-up for 3–6 months was to observe the clinical efficacy and postoperative complications of medical adhesive embolization treatment.

Results:

A total of 32 pseudoaneurysms were embolized in 31 patients with peripheral pseudoaneurysms. All pseudoaneurysms originated from visceral arteries. Among them, 29 pseudoaneurysms were embolized with medical adhesive alone, and three pseudoaneurysms were embolized with coil-assisted medical adhesive. After endovascular embolization with medical adhesive, all pseudoaneurysms were successfully embolized. Technical success was 100%. All patients experienced cessation of bleeding after endovascular embolization with medical adhesive, and there were no serious post-operative complications. Clinical success was 100%. During the follow-up period, two patients experienced recurrent bleeding but no pseudoaneurysm recurrence was observed.

Conclusion:

Endovascular medical adhesive embolization is a safe and effective method for treating pseudoaneurysm, with high hemostatic efficiency and permanent occlusion of the pseudoaneurysm after embolization, which is worthy of clinical promotion and application.

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Most cited references 21

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The endovascular management of visceral artery aneurysms and pseudoaneurysms.

Alissa K. Greenberg, Nirman Tulsyan, V. Kashyap … (2007)

Visceral artery aneurysms may be treated by aneurysm exclusion, excision, revascularization, and endovascular techniques. The purpose of this study was to review the outcomes of the management of visceral artery aneurysms with catheter-based techniques. Between 1997 and 2005, 90 patients were identified with a diagnosis of visceral artery aneurysm. This was inclusive of aneurysmal disease of the celiac axis, superior mesenteric artery (SMA), inferior mesenteric artery, and their branches. Surveillance without intervention occurred in 23 patients, and 19 patients underwent open aneurysm repair (4 ruptures). The endovascular treatment of 48 consecutive patients (mean age 58, 60% men) with 20 visceral artery aneurysms (VAA) and 28 visceral artery pseudoaneurysms (VAPA) was the basis for this study. Electronic and hardcopy medical records were reviewed for demographic data and clinical variables. Original computed tomography (CT) scans and fluoroscopic imaging were evaluated. The endovascular treatment of visceral artery aneurysms was technically successful in 98% of 48 procedures, consisting of 3 celiac axis repairs, 2 left gastric arteries, 1 SMA, 12 hepatic arteries, 20 splenic arteries, 7 gastroduodenal arteries, 1 middle colic artery, and 2 pancreaticoduodenal arteries. Of these, 29 (60%) were performed for symptomatic disease (5 ruptured aneurysms). Procedures were performed in the endovascular suite under local anesthesia with conscious sedation (94%). The femoral artery was used as the preferential access site (90%). Coil embolization was used for aneurysm exclusion in 96%. N-butyl-2-cyanoacrylate (glue) was used selectively (19%) using a triaxial system with a 3F microcatheter for persistent flow or multiple branches. The 30-day mortality was 8.3% (n = 4). One patient died from recurrent gastrointestinal bleeding after gastroduodenal embolization, and the remaining died of unrelated causes. All perioperative deaths occurred in patients requiring urgent or emergent intervention in the setting of hemodynamic instability. No patients undergoing elective intervention died in the periprocedural period. Postprocedural imaging was performed after 77% of interventions at a mean of 16 months. Complete exclusion of flow within the aneurysm sac occurred in 97% interventions with follow-up imaging, but coil and glue artifact complicated CT evaluation. Postembolization syndrome developed in three patients (6%) after splenic artery embolization. There was no evidence of hepatic insufficiency or bowel ischemia after either hepatic or mesenteric artery aneurysm treatment. Three patients required secondary interventions for persistent flow (n = 1) and recurrent bleeding from previously embolized aneurysms (n = 2). Visceral artery aneurysms and pseudoaneurysms can be successfully treated with endovascular means with low periprocedural morbidity; however, the urgent repair of these lesions is still associated with elevated mortality rates. Aneurysm exclusion can be accomplished with coil embolization and the selective use of N-butyl-2-cyanoacrylate. Current catheter-based techniques extend our ability to exclude visceral artery aneurysms, but imaging artifact hampers postoperative CT surveillance.

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Interventional Radiology in the Management of Visceral Artery Pseudoaneurysms: A Review of Techniques and Embolic Materials

Kumble Madhusudhan, Hosur Venkatesh, Shivanand Gamanagatti … (2016)

Visceral artery pseudoaneurysms occur mostly as a result of inflammation and trauma. Owing to high risk of rupture, they require early treatment to prevent lethal complications. Knowledge of the various approaches of embolization of pseudoaneurysms and different embolic materials used in the management of visceral artery pseudoaneurysms is essential for successful and safe embolization. We review and illustrate the endovascular, percutaneous and endoscopic ultrasound techniques used in the treatment of visceral artery pseudoaneurysm and briefly discuss the embolic materials and their benefits and risks.

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The role of interventional radiology in the management of abdominal visceral artery aneurysms.

Anna-Maria Belli, George Markose, Robert Morgan (2012)

Abdominal visceral artery aneurysms (VAA) include true and false aneurysms. The majority are asymptomatic and are discovered on cross-sectional imaging performed for unrelated clinical indications. With the maturation of techniques and devices used for embolization procedures and the treatment of aneurysms in other locations, most VAAs are now suitable for treatment by minimally invasive transcatheter techniques. The choice of technique used greatly depends on the local anatomy of the VAA and the experience of the interventional radiologist in complex vascular interventional techniques.

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Author and article information

Journal

Journal ID (nlm-ta): J Clin Imaging Sci

Journal ID (iso-abbrev): J Clin Imaging Sci

Journal ID (publisher-id): JCIS

Title: Journal of Clinical Imaging Science

Publisher: Scientific Scholar

ISSN (Print): 2156-7514

ISSN (Electronic): 2156-5597

Publication date (Electronic): 30 January 2024

Publication date Collection: 2024

Volume: 14

Electronic Location Identifier: 2

Affiliations

[1 ]Department of Interventional Diagnosis and Treatment, The First Affiliated Hospital of Shihezi University , Shihezi, Xinjiang Province, China.

Author notes

[* ] Corresponding author: Li-Ping Jiang, Department of Interventional Diagnosis and Treatment, The First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang Province, China. 1044152190@ 123456qq.com

Article

Publisher ID: 10.25259/JCIS_120_2023

DOI: 10.25259/JCIS_120_2023

PMC ID: 10858755

PubMed ID: 38344240

SO-VID: 7b3835b4-f373-4585-918f-d79fa79688ce

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

History

Date received : 01 November 2023

Date accepted : 16 December 2023

Funding

Financial support and sponsorship

Nil.

Clinical application of medical adhesive in endovascular embolization treatment of peripheral pseudoaneurysm

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Abstract

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Material and Methods:

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Most cited references 21

The endovascular management of visceral artery aneurysms and pseudoaneurysms.

Interventional Radiology in the Management of Visceral Artery Pseudoaneurysms: A Review of Techniques and Embolic Materials

The role of interventional radiology in the management of abdominal visceral artery aneurysms.

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