Transcatheter embolization of a cystic artery pseudoaneurysm in a cirrhotic patient with perforated acute cholecystitis

Maddineni, Shekher; Lim, Marc Michael D.; McCabe, Sam; Rozenblit, Grigory

doi:10.4103/ijri.ijri_358_16

Cited by 3 publications

(2 citation statements)

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“…Several studies involving patients with gastrointestinal bleeding, hemoptysis, post-partum bleeding, and musculoskeletal bleeding have reported favorable outcomes with respect to the safety and effectiveness of TAE (1)(2)(3)(4)(5). Bleeding originating from the cystic artery may be associated with surgical cholecystectomy, hemorrhagic cholecystitis, gallbladder cancer, and prior percutaneous drainage of the gallbladder (6)(7)(8)(9). Several case studies have documented the successful use of TAE in treating cystic artery bleeding (6)(7)(8)(9), and embolization procedures through the cystic artery have been safely attempted for the management of hepatocellular carcinoma (10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

“…Bleeding originating from the cystic artery may be associated with surgical cholecystectomy, hemorrhagic cholecystitis, gallbladder cancer, and prior percutaneous drainage of the gallbladder (6)(7)(8)(9). Several case studies have documented the successful use of TAE in treating cystic artery bleeding (6)(7)(8)(9), and embolization procedures through the cystic artery have been safely attempted for the management of hepatocellular carcinoma (10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

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Transcatheter arterial embolization of cystic artery bleeding

2023

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PurposeThe purpose of this study is to assess the safety and clinical outcomes of transcatheter arterial embolization (TAE) via the cystic artery for treating patients with bleeding from the cystic artery.Materials and MethodsThis retrospective study included 20 patients who underwent TAE via the cystic artery between January 2010 and May 2022. Radiological images and clinical data were reviewed to evaluate causes of bleeding, procedure-related complications, and clinical outcomes. Technical success was defined as the disappearance of contrast media extravasation or pseudoaneurysm, as demonstrated on completion angiography. Clinical success was defined as discharge from the hospital without any bleeding-related issues.ResultsHemorrhagic cholecystitis (n = 10) was the most common cause of bleeding, followed by iatrogenic (n = 4), duodenal ulcer (n = 3), tumor (n = 2), and trauma (n = 1). Technical success was achieved in all cases, and clinical success was achieved in 70% (n = 14) of patients. Three patients developed ischemic cholecystitis as a complication. Six patients with clinical failure died within 45 days after embolization.ConclusionTAE through the cystic artery has a high technical success rate in treating cystic artery bleeding, but clinical failure remains a common occurrence due to concurrent medical conditions and the development of ischemic cholecystitis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transcatheter arterial embolization of cystic artery bleeding

2023

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Cystic Artery Hemorrhage after Cholecystostomy Catheter Exchange Treated with Transcatheter Embolization

Sada

Metwalli

2019

Semin intervent Radiol

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The pathogenesis of formation of cystic artery pseudoaneurysms is not well understood, but is thought to result from erosion of the cystic artery wall from the adjacent inflammatory process associated with acute or chronic cholecystitis. The presented case discusses an incident of hemorrhage from a cystic artery pseudoaneurysm resulting in a large perihepatic hematoma as well as hemobilia, which developed after a routine cholecystostomy catheter exchange. This was treated with transcatheter embolization using ethylene-vinyl alcohol copolymer.

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Cystic Artery Pseudoaneurysm: Current Review of Aetiology, Presentation, and Management

Taghavi

kumar

Prabha

et al. 2021

Surgery Research and Practice

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Background. Cystic artery pseudoaneurysms are rare. Most commonly, they occur secondary to acute cholecystitis or after a cholecystectomy. Complications include haemobilia, biliary obstruction, and haemorrhage. Given the rarity and associated morbidity, a high index of suspicion is required. This article reviews the current literature on cystic artery pseudoaneurysms to investigate its aetiology, clinical presentation, and management options. Methods. A broad search of the Medline and PubMed databases was carried through. All peer reviewed literatures published in the English language between 1991 and 2020 with keywords “cystic” and “artery” and “pseudoaneurysm” in the title were selected for review. No further exclusion criteria; all studies yielded from the search were included in the results of this review. Additionally, we present a case of cystic artery pseudoaneurysm treated at our centre and included this in our analysis. Results. Sixty-seven case reports were found between 1991 and 2020. Aetiologies: Aetiology of cystic artery pseudoaneurysm was found to be cholecystitis in 41 instances (61.2%), cholecystectomy in 18 instances (26.8%), idiopathic in 6 instances (8.9%) cholelithiasis in 1 instance (1.5%), and pancreatitis in 1 instance (1.5%). Complications: Fifty-two cases were complicated by haemobilia (77.6%), 36 by anaemia (53.7%), 25 by biliary obstruction (37.3%), 13 by haemodynamic shock (19.4%), 9 by haemoperitoneum (13.4%), and 6 by contained rupture (8.9%). Most commonly, patients had two or more of these complications. Management: Forty-four patients were managed with endovascular embolisation (65.7%), 21 with endoscopic intervention (31.3%), 18 with open cholecystectomy (26.9%), 13 with laparoscopic cholecystectomy (19.4%), and 6 with pseudoaneurysm ligation (9%). Delayed presentation postcholecystectomy ranged from 8 days to 3 years. Conclusions. Cystic artery pseudoaneurysms are rare complications of a common operation. The most common clinical presentation is haemobilia, which can be difficult to diagnose clinically. A high index of suspicion and prompt investigation with targeted imaging and intervention is required. This is especially pertinent in gastrointestinal bleeding postlaparoscopic cholecystectomy as a missed diagnosis could cause significant morbidity.

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Transcatheter embolization of a cystic artery pseudoaneurysm in a cirrhotic patient with perforated acute cholecystitis

Cited by 3 publications

References 7 publications

Transcatheter arterial embolization of cystic artery bleeding

Transcatheter arterial embolization of cystic artery bleeding

Cystic Artery Hemorrhage after Cholecystostomy Catheter Exchange Treated with Transcatheter Embolization

Cystic Artery Pseudoaneurysm: Current Review of Aetiology, Presentation, and Management

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