Ultrasound-guided direct percutaneous embolization of abdominal artery pseudoaneurysms: a single-center experience

To evaluate the safety, efficacy and clinical scenarios of ultrasound guided direct percutaneous embolization (DPE) of abdominal artery pseudoaneurysms (PAs).

This retrospective study included 28 patients (mean age: 36.3 years; 23 males) who presented with abdominal hemorrhagic symptoms, showed PA on CT angiography and underwent DPE under ultrasound guidance between January 2016 and December 2023. The scenarios, clinical and embolization details, success rates and complications were evaluated. All patients were followed up with 24-hour US and then clinically (n = 28) and by imaging (n = 6) for 30 days.

Etiology of PAs were inflammatory (n = 16) and iatrogenic (n = 12). Right hepatic artery was the most common source (n = 9). DPE was performed upfront in 12 patients (42.9%), after angiography failed to show the source artery in 7 patients (25.0%) and in combination with endovascular embolization in 4 patients (14.3%). In the remaining 5 patients (17.9%), DPE was performed for recurrence of the PA after endovascular embolization. The technical success was 100.0%. N-butyl cyanoacrylate (NBCA) with iodized oil was the embolic agent used in all the patients (mean volume 1.13 ± 0.88 mL, median concentration 50.0%). Thrombin was used in addition to NBCA in two patients. The primary clinical success was 89.3% (25/28), with three patients showing patent PA at 24 hour follow up ultrasound. These underwent successful repeat DPE with NBCA (n = 2) and thrombin (n = 1) with a secondary clinical success rate of 100.0% (3/3). There were no major complications. Clinically insignificant non-target embolization was seen in two patients.

Ultrasound-guided direct percutaneous embolization appears to be a feasible, safe, and effective treatment option for abdominal artery pseudoaneurysms in selected patients with short-term follow-up.