Percutaneous Thrombin Injection to Complete SMA Pseudoaneurysm Exclusion After Failing of Endograft Placement

Abstract

Visceral aneurysms are potentially life-threatening vascular lesions. Superior mesenteric artery (SMA) pseudoaneurysms are a rare but well-recognized complication of chronic pancreatitis. Open surgical repair of such an aneurysm, especially in patients after previous surgical treatment, might be dangerous and risky. Stent graft implantation makes SMA pseudoaneurysm exclusion possible and therefore avoids a major abdominal operation. Percutaneous direct thrombin injection is also one of the methods of treating aneurysms in this area. We report a first case of percutaneous ultrasound-guided thrombin injection to complete SMA pseudoaneurysm exclusion after an unsuccessful endograft placement. Six-month follow-up did not demonstrate any signs of aneurysm recurrence.

Percutaneous treatment of a large superior mesenteric artery pseudoaneurysm and arteriovenous fistula: A case report

“…7,[9][10][11][12] In general, these reports (which comprise small numbers of patients) show durable results with duration of follow-up from 3 months to 5 years. [9][10][11][12] One case report described an endoleak at the distal edge of a covered stent at 3 months, 13 which was subsequently treated by thrombin injection. Visceral AV fistulae.…”

Splenic Artery Aneurysms

“…Ultrasound-guided percutaneous thrombin injection appears to be a viable method for treating failed endovascular interventions or even an alternative to initial endovascular treatment. (47). Actually, this technique is similar to thrombin injections for femoral artery pseudoaneurysms, were ultrasound or CT guidance or both are used to help delivering thrombin to the nidus of an aneurysm, thus facilitating thrombosis.…”

“…Reports of reperfusion and even rupture after successful embolization support that a thrombosed aneurysm may not represent the definitive treatment in all cases. (47,48).…”

Therapeutic management of superior mesenteric artery aneurysms

“…7,[12][13][14][15][16][17][18] In our study, both brachial and femoral accesses were used. First, the stent graft was introduced via the brachial artery.…”