Endovascular management of right gastroepiploic artery aneurysms and injuries

Right gastroepiploic artery lesions are rare but may cause life-threatening hemorrhage. They include not only aneurysms but also non-aneurysmal arterial injuries with diverse etiologies.

To evaluate the clinical spectrum, embolization strategies, and outcomes of transcatheter arterial embolization for right gastroepiploic artery aneurysms and injuries.

This retrospective single-center study included 29 patients with right gastroepiploic artery aneurysms or injuries treated with transcatheter arterial embolization between 2005 and 2025. Clinical presentation, etiology, lesion location, embolic materials, technical success, complications, recurrence, and surgical conversion were reviewed.

Ruptured lesions were observed in 10 patients and unruptured lesions in 19. Lesion size did not differ significantly between ruptured and unruptured lesions [13 mm (range, 3-28 mm) vs 15 mm (range, 4-35 mm), p = .46]. Etiologies included idiopathic or presumed true aneurysm, iatrogenic injury, trauma, segmental arterial mediolysis, tumor invasion, pancreatic fistula, and vasculitis. Technical success was achieved in 27 patients (93%), and clinical success in 26 (90%). One patient developed a small access-site hematoma. No clinically evident organ ischemia or lesion-related 30-day mortality occurred. Two patients required surgical conversion.

Transcatheter arterial embolization was technically and clinically successful in most patients with right gastroepiploic artery aneurysms and injuries, with a low rate of procedure-related complications. Treatment strategy should be tailored according to etiology, segmental location, collateral perfusion, and catheter accessibility.