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Embolization of a ruptured cystic artery pseudoaneurysm by percutaneous injection
Fatih Hakan Tufanoğlu1, Behiç Akyüz1
1Department of Radiology, Bursa City Hospital, Bursa, Turkey.
Insights
Percutaneous thrombin injection offers a minimally invasive treatment option for rare cystic artery pseudoaneurysms. This technique successfully occluded a pseudoaneurysm in an elderly patient, avoiding risks associated with surgery and contrast media.
Area of Science:
- Vascular surgery
- Interventional radiology
- Gastroenterology
Background:
- Cystic artery pseudoaneurysm is a rare condition, often presenting with life-threatening rupture and hemorrhagic shock.
- Diagnosis typically involves ultrasonography and contrast-enhanced tomography.
- Cholecystectomy is the traditional treatment, but can be risky in unstable patients.
Purpose of the Study:
- To present a case of an 86-year-old male with diabetes and Alzheimer's disease treated for a pseudoaneurysm.
- To highlight the technical aspects of percutaneous thrombin injection for pseudoaneurysm treatment.
- To evaluate the efficacy and safety of this minimally invasive approach.
Main Methods:
- Ultrasound-guided insertion of a 21-gauge Chiba needle into the pseudoaneurysm sac.
- Slow, controlled injection of 0.5 cc of thrombin for immediate occlusion.
- Post-procedure Doppler imaging to confirm pseudoaneurysm non-filling.
Main Results:
- The percutaneous thrombin injection successfully achieved instant occlusion of the pseudoaneurysm.
- Doppler imaging confirmed the absence of blood flow into the pseudoaneurysm post-procedure.
- This approach avoided the risks of surgery and contrast-induced nephropathy.
Conclusions:
- Percutaneous thrombin injection is a viable treatment option for gallbladder pseudoaneurysms, especially in patients where surgery poses high risks.
- The procedure is technically feasible and demonstrated immediate success in this case.
- Further research is needed to establish long-term success rates for this intervention.
Abstract:
BackgroundPseudoaneurysm of the cystic artery is very rare. It usually presents with rupture and hemorrhagic shock, which may be life-threatening. Ultrasonography and contrast-enhanced tomography can be used for the diagnosis. The mainstay of treatment for this disease is cholecystectomy.ObjectiveHere we present an 86-year-old man with known diabetes and Alzheimer's disease whose pseudoaneurysm was treated with percutaneous thrombin injection and highlight the technical aspect of the procedure.MethodWith ultrasonography guidance, a 21-gauge Chiba needle was passed through the liver and advanced into the pseudoaneurysm sac. A controlled, slow injection of 0.5-cc thrombin into the sac was performed with instant occlusion. Doppler imaging performed immediately following the procedure revealed that the pseudoaneurysm was not filled.ConclusionPseudoaneurysm of the gallbladder is extremely rare, and its diagnosis is difficult. If the condition is not treated right away, it can quickly become life-threatening. The majority of the pseudoaneurysms have already ruptured, and the patients are clinically septic, making surgery dangerous. Also, the use of contrast media in these patients may increase the risk of nephropathy, which is not an issue with percutaneous injection. Due to the obvious risk of rupture and bleeding, we propose injecting pseudoaneurysms only if they have a visible wall.ResultPercutaneous injection of the gallbladder pseudoaneurysms can be an option when treating gallbladder pseudoaneurysms. More research on long-term success rates is required.
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