REGULAR CONTENT
Final ID
594
Type
Educational Exhibit-Poster Only
Authors
W Malouf1, Q Jin2, M Neimark2, Y Golowa3, M Jagust3, J Cynamon2
Institutions
1Albert Einstein College of Medicine, Bronx, NY, 2Montefiore Medical Center, Bronx, NY, 3Montefiore Medical Center, New York, NY
Purpose
Due to a high risk of rupture, visceral pseudoaneurysms require treatment regardless of etiology. When endovascular approaches fail, direct percutaneous puncture of pseudoaneurysms has been shown to be a viable alternative. We present 3 consecutive cases of direct visceral pseudoaneurysm puncture after failed endovascular attempts. We discuss the imaging modalities employed in these situations, including the recent application of cone beam CT (CBCT) with needle path overlay.
Materials & Methods
Three patients underwent percutaneous embolization of pseudoaneurysms of the pancraticoduodenal or hepatic arteries. In each case, endovascular embolization attempts failed due to the inability to cannulate or identify all significant feeding vessels. None of the cases were amenable to ultrasound guidance due to body habitus or overlying gas. One case employed fluoroscopic guidance using existing fiducial coils. In another case, percutaneous needle placement was performed during the attempted transarterial procedure using digital subtraction roadmapping. The third case utilized CBCT guidance with needle path overlay. Each case used a 21 gauge echotip trocar needle to directly puncture the pseudoaneurysm. Once direct puncture was confirmed, either Onyx embolic agent or Onyx in combination with coils was employed to abolish the pseudoaneurysm.
Results
In all the cases, the pseudoaneurysm was successfully embolized and bleeding resolved. There were no significant complications due to the embolization procedures. In the case guided by CBCT, the patient recovered completely and was discharged to subacute rehabilitation. In the remaining two patients, one eventually succumbed to other medical issues and the other was transferred to palliative care.
Conclusions
Our experience supports the observation that direct puncture of pseudoaneurysms is a viable approach to pseudoaneurysm embolization. A number of imaging modalities are available to guide these procedures, including ultrasound, fluoroscopy, and CT. We believe that this is the first report of the application of CBCT in the embolization of a bleeding visceral pseudoaneurysm. We conclude that it is a useful addition to the imaging guidance options for this approach.
Final ID
594
Type
Educational Exhibit-Poster Only
Authors
W Malouf1, Q Jin2, M Neimark2, Y Golowa3, M Jagust3, J Cynamon2
Institutions
1Albert Einstein College of Medicine, Bronx, NY, 2Montefiore Medical Center, Bronx, NY, 3Montefiore Medical Center, New York, NY
Purpose
Due to a high risk of rupture, visceral pseudoaneurysms require treatment regardless of etiology. When endovascular approaches fail, direct percutaneous puncture of pseudoaneurysms has been shown to be a viable alternative. We present 3 consecutive cases of direct visceral pseudoaneurysm puncture after failed endovascular attempts. We discuss the imaging modalities employed in these situations, including the recent application of cone beam CT (CBCT) with needle path overlay.
Materials & Methods
Three patients underwent percutaneous embolization of pseudoaneurysms of the pancraticoduodenal or hepatic arteries. In each case, endovascular embolization attempts failed due to the inability to cannulate or identify all significant feeding vessels. None of the cases were amenable to ultrasound guidance due to body habitus or overlying gas. One case employed fluoroscopic guidance using existing fiducial coils. In another case, percutaneous needle placement was performed during the attempted transarterial procedure using digital subtraction roadmapping. The third case utilized CBCT guidance with needle path overlay. Each case used a 21 gauge echotip trocar needle to directly puncture the pseudoaneurysm. Once direct puncture was confirmed, either Onyx embolic agent or Onyx in combination with coils was employed to abolish the pseudoaneurysm.
Results
In all the cases, the pseudoaneurysm was successfully embolized and bleeding resolved. There were no significant complications due to the embolization procedures. In the case guided by CBCT, the patient recovered completely and was discharged to subacute rehabilitation. In the remaining two patients, one eventually succumbed to other medical issues and the other was transferred to palliative care.
Conclusions
Our experience supports the observation that direct puncture of pseudoaneurysms is a viable approach to pseudoaneurysm embolization. A number of imaging modalities are available to guide these procedures, including ultrasound, fluoroscopy, and CT. We believe that this is the first report of the application of CBCT in the embolization of a bleeding visceral pseudoaneurysm. We conclude that it is a useful addition to the imaging guidance options for this approach.