Coil migration – a rare complication of endovascular exclusion of visceral artery pseudoaneurysms and aneurysms

Abstract

INTRODUCTIONWe describe a case of metallic, angiographic coil migration, following radiological exclusion of a gastroduodenal artery pseudoaneurysm secondary to chronic pancreatitis. PATIENTS AND METHODS A 55-year-old man presented to the out-patient clinic with chronic, intermittent, post-prandial, abdominal pain, associated with nausea, vomiting and weight loss. He was known to have chronic pancreatitis and liver disease secondary to alcohol abuse and previously underwent angiographic exclusion of a gastroduodenal artery pseudoaneurysm. During subsequent radiological and endoscopic investigation, an endovascular coil was discovered in the gastric pylorus, associated with ulceration and cavitation. This patient was managed conservatively and enterally fed via naso-jejunal catheter endoscopically placed past the site of the migrated coil. This patient is currently awaiting biliary bypass surgery for chronic pancreatitis, and definitive coil removal will occur concurrently. CONCLUSIONS Literature review reveals that this report is only the eighth to describe coil migration following embolisation of a visceral artery pseudoaneurysm or aneurysm. Endovascular embolisation of pseudoaneurysms and aneurysms is generally safe and effective. More common complications of visceral artery embolisation include rebleeding, pseudoaneurysm reformation and pancreatitis.

Endoscopic Removal of a Migrated Coil after Embolization of a Splenic Pseudoaneurysm: A Case Report

“…According to a cumulative review of the literature, there are only 10 reports documenting the migration of endovascular coils from visceral arteries (Table 1). 1,10,11,12,13,14,15,16,17,18 In two cases, the coils migrated from the splenic artery, as in our case, one into the stomach10 and the other into the rectum 11. In the former case, the splenic pseudoaneurysm resulting from chronic pancreatitis bled into pseudocyst, and steel-wire coils were placed inside the aneurysm cavity.…”

“…To reduce the chance of coil migration, occluding the normal portion of the splenic artery, both distal and proximal to the pseudoaneurysm, is preferred over filling the inside of a pseudoaneurysm 10. By occluding both sides of the artery, backflow from collateral circulation could be prevented 1. In our case, the radiologists tried to occlude both the afferent and efferent arteries; however, the blood flow was so fast that some of the coils migrated into the pseudoaneurysm.…”

Late-occurring coil migration into the duodenum

“…Late-occurring coil migration is very rare, particularly migration into the gastrointestinal tract 1 2. We speculate that coil migration into the duodenum through the tract from an adhesive inflammatory pseudoaneurysm was associated with enteric peristalsis.…”

Endovascular coil erosion into the duodenum following gastroduodenal artery angioembolization

“…In previously reported cases, symptomatic patients with coil migration underwent or were planned to undergo removal of the coil. 1,3,4 A laparotomy and duodenotomy to remove the coil has been previously reported; 5 however, given our patient was asymptomatic and in the context of significant comorbidities, the risks of major surgery were thought to outweigh the benefit of coil extraction in the elective setting. It is worth noting that spontaneous passage of a migrated coil has been previously reported without significant sequelae and therefore this approach would seem reasonable.…”

“…1,2 Erosion of an endovascular coil into the stomach has previously been reported to cause abdominal pain, weight loss, dyspepsia and severe anaemia requiring blood transfusion. 3,4 This article reports a case of asymptomatic coil migration into the duodenal lumen following GDA pseudoaneurysm angioembolization identified incidentally at endoscopy and is the first reported case of vascular coil erosion through the duodenum in the literature. In previously reported cases, symptomatic patients with coil migration underwent or were planned to undergo removal of the coil.…”