Duplex-Ultrasound Guided Percutaneous Management of Pseudoaneurysm of Branch of Visceral Artery

Background: To describe the role of Duplex-Ultrasound Imaging (DUI) for diagnosis of pseudoaneurysm (PSA) of a branch of offending visceral artery (b-OVA) followed by DUI-guided percutaneous embolization. Method(s): 46 patients were referred to us for the management of intractable renal hematuria. 21 cases had PSA after nephrolithotomy. 12 cases had PSA after guided renal biopsies. 6 cases had PSA following road-traffic accident. 2 cases of the tuberous-sclerosis-complex developed PSA. 3 cases of arterio-venous and 2 cases of arterio-calyceal fistulae had been excluded from cohort. 6 cases of intractable vaginal/uterine haemorrhage. Among these, a unique complex case presented with post-hysterectomy and in subsequent course of management, surgical ligation of anterior division of both iliac arteries and 5 cases presented after cesarian surgery/dilatation and curettage, 4 cases of post-traumatic G.I. Bleed due developed PSA of b-hepatic artery, 10 cases of pancreatitis induced PSA from b-GDA and splenic arteries. 5 cases of G.I. bleed had bowel tumours were excluded by CTA. Total 61 PSA of b-OVA were included. DUI-guided-percutaneous-management (DPM) is a four-step process. Firstly, identification of PSA-sac of b-OVA. Secondarily, puncture of PSA-sac with 18 G puncture-needle under DUI. Subsequently, injection of gelfoam-slurry followed by NBCA-glue. Thrombosis of the PSA-sac was confirmed by absent flow on DUI during the procedure. Result(s): 60 PSA of b-OVA managed successfully and followed-up clinically, by DUI and CT-Angiography (if needed). A case of large sized (5x4 cm size) PSA of b-segmental-renal-artery developed pulmonary-thromboembolism and managed end-vascular coiling. Conclusion(s): DPM of PSA of b-OVA is safe, feasible and cost-effective modified embolisation management technique in a limited resources scenario.

Publication History

Article published online:
11 May 2021