Management of distal aneurysm of the superior mesenteric artery by percutaneous ultrasound-guided Onyx injection: A case report

Abstract

Objectives The aim of this article is to report an alternative approach for the management of a distal aneurysm of superior mesenteric artery using direct percutaneous ultrasound-guided Onyx injection. Methods We report a rare case of symptomatic superior mesenteric artery aneurysm. A 78-year-old man presents with pain and pulsating mass in the right umbilical region of the abdomen. The patient was treated by percutaneous ultrasound-guided Onyx injection after several failing transarterial embolization attempts. Results The procedure was successful without any complication, and the patient wasdischarged to home the day after procedure. Follow-up at 60 months confirmed the complete thrombosis of the aneurysm sac. Ultrasound-guided Onyx injection for distal superior mesenteric artery aneurysm could provide an alternative to transcatheter arterial embolization or open surgery. Anatomical assessment of collaterals and knowledge of abdomen anatomy could play important roles in preventing bowel ischemia and minimizing the risk of procedural complication. Conclusion Ultrasound-guided Onyx injection of superior mesenteric artery aneurysm is a feasible, effective, and cost-saving technique that can be used when endovascular approach is not possible or has failed.

Non-Adhesive Liquid Embolic Agents in Extra-Cranial District: State of the Art and Review of the Literature

“…Recently, Simoncini et al [ 78 ] published a case report demonstrating the embolization with an echo-guided percutaneous approach of a distal aneurysm of the superior mesenteric artery with a non-adhesive embolic fluid, confirming that, although highly experienced operators are required, this technique can be a valid alternative to the endovascular approach. Obviously, it is necessary to inject the fluid slowly so that it can solidify while it occupies the sac and thus reduce the risks of peripheral embolization.…”

Visceral Artery Aneurysms Embolization and Other Interventional Options: State of the Art and New Perspectives

“…In the past, non-adhesive liquid embolic agents have been widely used in intracranial district for cerebral aneurysms [ 61 ], but rarely in abdominal district for VAAs [ 62 ]. Nowadays, ethylene vinyl alcohol copolymer (EVOH) agents, well-known as Onyx (Medtronic, Dublin, Ireland), Squid (Emboflu, Gland, Switzerland) and Phil (Precipitating Hydrophobic Injectable Liquid, MicroVention, Terumo, Austin, USA), are routinely used in many abdominal diseases [ 63 , 64 , 65 , 66 , 67 ] and also in splenic [ 68 ], hepatic [ 69 ], mesenteric [ 70 ] and renal aneurysms [ 71 ]. These liquid embolic agents are EVOH copolymers mixed with micronized tantalum powder and dissolved in dimethyl sulfoxide (DMSO).…”

“…The percutaneous approach may be performed alone or combined with an endovascular procedure, for example coil embolization [ 102 ]. Aneurysm thrombosis can be achieved carefully injecting thrombin, glue or EVOH liquid embolic agents under real-time imaging control [ 58 , 70 , 103 ]. Aneurysm sac opacification may be also obtained by direct contrast filling under fluoroscopic control, to check for the presence of efferent vessels.…”