Transcatheter Arterial Embolization of Splanchnic Arterial Pseudonaneurysm: Focus on the Method of Embolization

ABSTRACT

PURPOSE: To evaluate the effectiveness of transarterial embolization of splanchnic arterial pseudoaneurysm and to analyze the embolization technique. MATERIALS AND METHODS: Between 1991 and 1999, 38 patients with splanchnic arterial pseudoaneurysm underwent tarnsarterial coil embolization. The parent artery was embolized just distal and proximal to the neck of the pseudoaneurysm in 26 cases, and proximal to the aneurysmal neck in nine. In four patients, embolization involved the use of gelfoam, and in the other two patients, coil packing of the pseudoaneurysm sac was performed. RESULTS: Initial bleeding was controlled in 34 of the 38 patients (89%) treated by transarterial embolization (in 24 of 26 who underwent distal and proximal embolization, in seven of nine whose treatment involved proximal embolization and in two of four in whom gelfoam embolization was undertaken). In seven patients (18%), rebleeding occurred within 0 -14 (mean, 6.4) days of initial embolization. In two cases, bleeding reoccurred from the same artery initially treated by gelfoam embolization, in two others from that in which coil packing of the pseudoaneurysmal sac had been performed, and in three, from a different artery. Among these seven patients, one died from bleeding and the remaining six were successfully treated by repeated embolization. In spite of successful bleeding control, nine patients (24%) died of subsequent bleeding-related complications, namely sepsis (n=4), acute respiratory failure (n=3), and multi-organ failure (n=2). CONCLUSION: For the treatment of splanchnic arterial Pseudoaneurysm, transarterial embolization was a relatively simple and effective procedure. Proximal and distal coil embolization at the pseudoaneurysmal neck successfully isolated the of pseudoaneurysm and prevented the recanalization of blood flow.