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DOI: 10.1055/a-2493-3544
Endoscopic ultrasound-guided coil and glue treatment for gastroduodenal artery pseudoaneurysm
Authors
Supported by: National Natural Science Foundation of China 82000608
Supported by: Science and Technology Project of Zhejiang Province, China 2022C04037
Supported by: Natural Science Foundation of Zhejiang Province, China LQ20H30007
Gastroduodenal artery pseudoaneurysm (GDAP) is usually treated by transcatheter arterial embolization (TAE) [1]. However, when the pseudoaneurysm combines with an abnormal course of the artery, TAE may fail. Herein, we report a case in which endoscopic ultrasound-guided coil and glue injection (EUS-CGI) was useful for treatment of a GDAP.
A 58-year-old man with a GDAP underwent TAE prior to presentation to our hospital. The TAE failed due to the variant course of a communicating artery ([Fig. 1]). An ultrasound endoscope was introduced, and a 22-gauge puncture needle (EchoTip, Ultra Endoscopic Ultrasound Needle; Cook Medical, Bloomington, Indiana, USA) was selected to penetrate the GDAP. A preloaded 0.018-inch fibered interlock detachable coil (F-IDC; 2D 12 mm, 30 cm; Boston Scientific, Marlborough, Massachusetts, USA) and two 0.18-inch pushable coils (2D 12 mm, 5 cm; Boston Science, Marlborough, Massachusetts, USA) were slowly pushed out of the needle tip into the entrance of the GDAP. Thereafter, 2 ml saline followed by 0.5 ml glue and 2 ml saline was injected rapidly. Subsequent color Doppler imaging showed that the blood flow had disappeared ([Video 1]).
Gastric arterial CT angiography (CTA) was performed for follow-up and revealed the GDPA to be partially filled with contrast ([Fig. 2]). The patient was therefore readmitted. Under EUS, the GDAP showed a hyperechoic mass with posterior acoustic shadow. Flows could be seen in the residual cavity, and pulsed wave Doppler imaging showed arterial blood flow, indicating recanalization. The residual cavity was punctured with a 22-gauge needle. Two 0.18-inch pushable coils were slowly placed. Thereafter, 2 ml saline followed by 0.5 ml glue and 2 ml saline was injected rapidly. Doppler imaging after the intervention showed the flow to have disappeared ([Video 1]). Gastric arterial CTA was performed 2 days later and showed no obvious contrast filling ([Fig. 3]).
EUS-CGI as a treatment for GDAP makes use of the natural lumen of the digestive tract. It is not only a safe and effective treatment for GDAP, but also is repeatable, accurate, and avoids radiation exposure.
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Conflict of Interest
The authors declare that they have no conflict of interest.
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Reference
- 1 Mann R, Goyal H, Perisetti A. et al. Endoscopic ultrasound-guided vascular interventions: current insights and emerging techniques. World J Gastroenterol 2021; 27: 6874-6887
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Publication History
Article published online:
19 December 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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Reference
- 1 Mann R, Goyal H, Perisetti A. et al. Endoscopic ultrasound-guided vascular interventions: current insights and emerging techniques. World J Gastroenterol 2021; 27: 6874-6887