Percutaneous Glue Embolization of a Visceral Artery Pseudoaneurysm in a Case of Sickle Cell Anemia

Abstract

Although aneurysmal complications of sickle cell anemia have been described in the intracranial circulation, visceral artery pseudoaneurysms in this disease entity have not previously been reported in the literature. Conventional treatment of visceral pseudoaneurysms has been surgical ligation or resection of the aneurysm. Transcatheter embolization has emerged as an attractive, minimally invasive alternative to surgery in the treatment of these lesions. In certain situations, however, due to the unfavorable angiographic anatomy precluding safe transcatheter embolization, direct percutaneous glue injection of the pseudoaneurysm sac may be considered to achieve successful occlusion of the sac. The procedure may be rendered safer by simultaneous balloon protection of the parent artery. We describe this novel treatment modality in a case of inferior pancreaticoduodenal artery pseudoaneurysm in a patient with sickle cell anemia. Although a complication in the form of glue reflux into the parent vessel occurred that necessitated surgery, this treatment modality may be used in very selected cases (where conventional endovascular embolization techniques are not applicable) after careful selection of the balloon diameter and appropriate concentration of the glue-lipiodol mixture.

A pseudoaneurysm within a subperiosteal collection in a patient with sickle cell disease

“…A previous report has detailed a case of a visceral artery pseudoaneurysm in a 22-year-old patient with SCD, which was managed by combined endovascular and direct percutaneous access intervention. 4 In the present case, it is possible that a combination of the infected subperiosteal collection and the weakened wall of the cortical blood vessel (as hypothesized above) may have contributed to the formation of the pseudoaneurysm. Since the patient was already clinically improving on antibiotics, we chose to follow-up the patient on color Doppler alone.…”

Minimally invasive image-guided interventional management of hepatic artery pseudoaneurysms

“…21 Percutaneous injections of cyanoacrylate glue into the visceral, renal and femoral pseudoaneurysms have also been reported rarely. [22][23][24] It requires significant precision and operator experience.…”

Percutaneous Cyanoacrylate Glue Embolization for Peripheral Pseudoaneurysms: An Alternative Treatment

“…This can lead to ischemia of the normal structures. There are reports of small bowel stricture due to glue spillover following treatment of visceral pseudoaneurysms [15]. In our second case, although there was some spillover of glue, it was only into small muscular branches, and not into the main vessel, and was thus asymptomatic.…”

“…The main drawback of the use of cyanoacrylate glue is the possibility of reflux of the glue in the parent vessel [15]. This can lead to ischemia of the normal structures.…”

“…In our second case, although there was some spillover of glue, it was only into small muscular branches, and not into the main vessel, and was thus asymptomatic. Balloon protection of the parent artery [15] (as was done in case 1) as well as ultrasound compression of the neck [13] help to reduce the risk of spillover of glue.…”