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Percutaneous coil embolization of massive pelvic pseudoaneurysm in an infant
Anna P Lillis1, Raja Shaikh, Ahmad I Alomari
1Division of Vascular and Interventional Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA, anna.lillis@childrens.harvard.edu.
Insights
This case report details a rare complication of cardiac catheterization: an iatrogenic pseudoaneurysm in a 3-month-old boy. The pseudoaneurysm was successfully treated using percutaneous embolization.
Area of Science:
- Cardiovascular Medicine
- Pediatric Cardiology
- Interventional Radiology
Background:
- Iatrogenic pseudoaneurysms are rare but serious complications following cardiac catheterization.
- Aortic coarctation is a congenital heart defect requiring interventions like balloon dilatation.
Observation:
- A 3-month-old boy developed a large left external iliac artery pseudoaneurysm after cardiac catheterization and aortic balloon dilatation.
- A 4-cm pulsatile mass was detected via MRI, with sonography and angiography confirming the pseudoaneurysm.
Findings:
- The pseudoaneurysm arose distal to the iliac bifurcation, causing absent distal flow in the external iliac artery.
- Initial percutaneous ultrasound-guided thrombin injections yielded partial recanalization.
- Successful treatment was achieved through percutaneous coil embolization under ultrasound and fluoroscopic guidance.
Implications:
- This case highlights the importance of recognizing and managing iatrogenic pseudoaneurysms in infants post-cardiac procedures.
- Percutaneous embolization offers a viable treatment option for managing such vascular complications in pediatric patients.
- Multimodality imaging and interventional techniques are crucial for diagnosis and successful treatment.
Abstract:
Iatrogenic pseudoaneurysm formation is an uncommon but potentially serious complication of cardiac catheterization. This case report describes diagnosis and treatment of a large left external iliac artery pseudoaneurysm in a 3-month-old boy following cardiac catheterization and aortic balloon dilatation for aortic coarctation. A 4-cm pulsatile mass in the left hemipelvis was discovered on MRI performed 6 weeks later for possible tethered spinal cord. Sonography and angiography showed a large pseudoaneurysm of the left external iliac artery just distal to the iliac bifurcation with no flow in the external iliac artery distal to the pseudoaneurysm. Percutaneous US-guided thrombin injection was performed twice, with partial recanalization after each treatment. The residual portion of the pseudoaneurysm was then successfully embolized with percutaneous coils deployed under US and fluoroscopic guidance.
