Transcatheter embolization of splanchnic aneurysms/pseudoaneurysms: early imaging allows detection of incomplete...

The purpose of this work is to discuss results of transcatheter embolization for splanchnic aneurysms/pseudoaneurysms and to evaluate the value of color Doppler ultrasonography and CT within the first week after the procedure.

Retrospective review of selected patients from our database with splanchnic artery aneurysms and pseudoaneurysms treated by transcatheter embolization was conducted. Patients were selected and treated in the hospital of Edouard Herriot (Lyon, France). Conventional angiography was performed by the transfemoral route in all patients. We used association of steel coils with or without hemostatic sponge after selective catheterization of the parent vessel for the embolization of the aneurysm. Color flow imaging on ultrasonography and CT scan with contrast medium injection were performed to analyze feeding arteries, treated aneurysm, and presence of complications within the first week after embolization.

Eighteen transcatheter embolizations were performed in 14 patients. A total of 25 ultrasonograms and/or CT scans were performed within the first week after the embolization procedure. Complete embolization in one attempt was achieved in eight patients. Imaging follow-up confirmed the absence of recurrence, recanalization, or severe complication for these patients. In one patient, a CT scan with injection of contrast medium done after the first complete procedure of embolization for mycotic pseudoaneurysm identified new aneurysms. Further embolization was done to complete the procedure. In the remaining four patients, large aneurysms were identified, with failure of transcatheter embolization. Follow-up imaging confirmed either the incomplete packing of the aneurysm or recanalization by a new feeding artery.

Imaging follow-up with ultrasonography and CT scan provides significant information after transcatheter embolization. We confirm that large visceral aneurysms are difficult to treat by embolization, with failed procedures in our series.