Pseudoaneurysm of the inferior gluteal artery.

Aneurysms of the inferior gluteal artery are uncommon, and have not previously been described in detail in the radiologic literature. The authors report the findings of computed tomography and angiography for a patient with a pseudoaneurysm of the inferior gluteal artery who was successfully treated by embolization alone.     

臀部创伤性假性动脉瘤的栓塞治疗及其并发症

目的 探讨臀部创伤性假性动脉瘤的栓塞治疗方法及其并发症。资料与方法 9例臀部创伤性假性动脉瘤患者,行选择性动脉插管至载瘤动脉,造影明确诊断后采用明胶海绵和／或弹簧钢圈栓塞,并对栓塞治疗的方法和可能出现的并发症进行分析。结果 9例均发生于髂内动脉分支,其中臀上动脉3例,阴部内动脉3例,臀下动脉2例,闭孔动脉1例,均成功栓塞,随访2个月均痊愈,无严重并发症发生。结论 经导管栓塞臀部创伤性假性动脉瘤是一种安全、有效且并发症少的治疗方法。     

Traumatic Inferior Gluteal Artery Aneurysm Managed with Emergency Transcatheter Thrombin Injection

Pseudoaneurysms of the inferior gluteal artery (IGA) are rare and are often caused by trauma. Treatment options vary and include surgery, ultrasound-guided percutaneous thrombin injection, and endovascular procedures such as stent-graft placement, coil embolization, and glue injection. We report a 70-year-old male who presented to the hospital after a road accident with a posttraumatic pseudoaneurysm that was treated by endovascular thrombin embolization. To the best of our knowledge, this is the first reported case of inferior gluteal artery false aneurysm treated by this method.     

Pseudoaneurysm of the superior gluteal artery following polytrauma

Gluteal artery aneurysms are rare and often secondary to pelvic fractures, blunt or penetrating trauma. We describe a case of a superior gluteal artery pseudoaneurysm that presented as back pain with numbness and weakness of the lower extremities. Diagnosis was confirmed by color Doppler sonography and angiography. A proximal and distal control was obtained over the aneurysm neck via coil embolization with excellent hemostasis within the pseudoaneurysm and maintenance of perfusion to the left pelvis.     

Superficial temporal artery pseudoaneurysm: diagnosis and preoperative planning with CT angiography

We report the use of CT angiography in the diagnosis and preoperative planning of a superficial temporal artery pseudoaneurysm. A 50-year-old man presented with a pulsatile preauricular mass 4 weeks after undergoing pterional craniotomy for aneurysm repair. CT angiography revealed a 2.5-cm pseudoaneurysm arising from the posterior margin of the right superficial temporal artery at the inferior margin of the craniotomy incision. To our knowledge, this is the first reported case showing the usefulness of CT angiography alone in the diagnosis and characterization of a superficial temporal artery pseudoaneurysm.     

分析子宫动脉起源及开口情况对栓塞治疗子宫肌瘤的意义

目的对子宫动脉起源及开口情况进行分析,提高栓塞治疗子宫肌瘤的成功率。资料与方法71例子宫肌瘤患者进行双侧髂内及子宫动脉造影,观察子宫动脉起源及开口情况,并比较用不同投照角度造影对子宫动脉的显示情况。结果40.8%子宫动脉起源于臀下阴部干;29.6%源于臀下动脉;18.3%源于阴部内动脉,8.5%源于脐动脉,2.8%髂内动脉主干。47.3%子宫动脉在正位造影显示较好,86.2%子宫动脉在10°~30°右斜位造影或10°~30°左斜位造影显示较好。结论多数患者子宫动脉发自髂内动脉分支;斜位造影显示子宫动脉优于正位造影。     

The role of pulmonary CT angiography and selective pulmonary angiography in endovascular management of pulmonary artery pseudoaneurysms associated with infectious lung diseases

PURPOSE: To determine the value of performing selective angiography based on the findings of pulmonary computed tomographic (CT) angiography for the detection of a pulmonary artery pseudoaneurysm (PAP) associated with infectious lung diseases and to evaluate the usefulness of endovascular management of these PAPs. MATERIALS AND METHODS: Over a 6-year period, 11 PAPs were diagnosed in 10 patients (seven men and three women; age, 23-84 years). All patients presented with massive hemoptysis. The underlying diseases were cavitary pulmonary tuberculosis (n = 7), lung abscess (n = 2), and a fungus ball (n = 1). The detection rates of PAP by bronchial/thoracic angiography, main pulmonary angiography, and selective pulmonary angiography were analyzed. When a pseudoaneurysm was detected, feeding artery occlusion was performed with coils or n-butyl cyanoacrylate. RESULTS: The findings of main pulmonary angiography were contrast agent filling of the pseudoaneurysm (n = 4) and hypoperfusion of the diseased pulmonary segment without contrast agent filling of the pseudoaneurysm (n = 6). The selective angiogram based on pulmonary CT angiography demonstrated five cases of pseudoaneurysm that were not found on the main pulmonary angiogram. Embolization of the pseudoaneurysm was successfully performed in nine of the 10 patients. One patient experienced a rupture of the subsegmental branch of the inferior pulmonary artery during the procedure. CONCLUSION: Because main pulmonary angiography alone may fail to demonstrate a pseudoaneurysm, a selective angiogram based on the anatomic information obtained from pulmonary CT angiography is essential for detection of a pseudoaneurysm. In addition, endovascular management of a PAP appears to be a safe and effective treatment.     

介入治疗在腹部外科术后消化道大出血中的应用价值

目的确定介入治疗在腹部外科术后消化道大出血中的应用价值。方法回顾性分析11例腹部外科手术后急性消化道大出血并经内科保守治疗无效而介入治疗的病例,总结其DSA结果及介入治疗价值。结果11例腹部外科术后消化道出血患者中DSA发现胃左动脉出血1例,胃十二指肠动脉假性动脉瘤4例,肝动脉假性动脉瘤2例,脾动脉假性动脉瘤1例,肠系膜下动脉分支血管感染性假性动脉瘤1例,肠系膜上动脉小分支血管出血2例。结论介入治疗是治疗腹部外科术后消化道大出血的有效方法。     

Successful embolization of a large superior gluteal artery pseudoaneurysm emerging during anticoagulant therapy

Gross hemorrhage is the most serious complication of anticoagulant therapy. We report the discovery and treatment of a large pseudoaneurysm of the superior gluteal artery in one patient who had been receiving oral anticoagulant therapy. We diagnosed the pseudoaneurysm by contrast-enhanced computed tomography, and embolized the artery with stainless steel coils. The exact cause of the pseudoaneurysm remains unclear, however, minor trauma appears most likely.     

Massive hemoperitoneum due to ruptured inferior phrenic artery pseudoaneurysm after blunt trauma

There had been no previous reports of ruptured pseudoaneurysm of inferior phrenic artery shortly after blunt abdominal trauma. Traumatic arterial pseudoaneurysms are either iatrogenic or the result of penetrating injuries and one of the sequelae of trauma. Post-traumatic pseudoaneurysm develops at varying time intervals after the initial insult. To our knowledge, this is the first report of massive hemoperitoneum caused by ruptured inferior phrenic artery pseudoaneurysm after blunt trauma. Pseudoaneurysm of inferior phrenic artery in patient with diaphragm injury is potentially a life-threatening condition and requires urgent management. Diagnosis of ruptured inferior phrenic artery pseudoaneurysm is based on clinical assessment combined with radiological investigations. We report a case of ruptured left inferior phrenic artery pseudoaneurysm as one aspect of massive hemoperitoneum caused by blunt abdominal trauma.     

Color doppler sonography in the follow-up of giant glutealaneurysm embolization.

False aneurysm of the gluteal artery is uncommon and may develop secondary to penetrating gluteal injury or pelvic trauma. The use of color Doppler sonography may allow the initial diagnosis of gluteal pseudoaneurysms and provide information about the success of the interventional radiological procedures. In this study, color Doppler sonographic examination demonstrated the failure of the endovascular treatment of a giant superior gluteal artery pseudoaneurysm. The second intervention of super-selective coil embolization provided optimal thrombosis and eliminated the need for open surgery.     

Pseudoaneurysm embolization and vasopressin infusion for lower gastrointestinal bleeding due to recurrence of urinary bladder carcinoma

We report a case that was successfully treated for massive lower gastrointestinal (LGI) bleeding due to a recurrent urinary bladder carcinoma. Treatment consisted of combination therapy including embolization of an inferior gluteal artery (IGA) pseudoaneurysm and low-dose arterial vasopressin infusion via a sigmoid artery (SA). A 57-year-old man presented with life-threatening sudden, massive LGI bleeding due to an obturator lymph node (LN) metastasis from a urinary bladder carcinoma. Computed tomography showed that the LN recurrence had invaded all the way to the sigmoid colon, and there was a pseudoaneurysm with extravasation inside the recurrence. An angiogram revealed a left IGA pseudoaneurysm. We therefore excluded the pseudoaneurysm by embolization with microcoils. Following this treatment the bleeding decreased, but intermittent LGI bleeding continued. Endoscopic examination showed the tumor with a huge ulcer inside the colonic lumen, and continuous oozing was confirmed. A second angiogram showed no recurrence of the IGA pseudoaneurysm and no apparent findings of bleeding. Then a 3F microcatheter was placed in the SA selectively using a coaxial catheter system, and vasopressin was infused at a rate 0.05 U/min for 12 h. Bleeding completely ceased 2 days later. There were no signs of ischemic gastrointestinal complications. Massive LGI bleeding has not recurred in 5 months.     

Computed tomography and magnetic resonance imaging of a superior gluteal artery pseudoaneurysm

The magnetic resonance and computed tomography appearances of a superior gluteal artery pseudoaneurysm are described, with emphasis on the relative advantages and disadvantages of these two imaging procedures.     

Transcatheter embolization of a pseudoaneurysm of the inferior epigastric artery with N-butyl cyanoacrylate

A 41-year-old man presented with alcoholic liver cirrhosis with ascites and clotting abnormality. After therapeutic paracentesis, haemoperitoneum ensued without colour Doppler ultrasound or CT evidence of pseudoaneurysm or haematoma at the site of paracentesis. However, an angiogram of the inferior epigastric artery revealed an obvious small pseudoaneurysm arising from its small muscular branch, and this pseudoaneurysm was successfully treated by transcatheter embolization with N-butyl cyanoacrylate. Transcatheter embolization with N-butyl cyanoacrylate is useful treatment for pseudoaneurysms arising from the small muscular branch of the inferior epigastric artery, which cannot be catheterized superselectively close to the pseudoaneurysm.     

Pushable springcoil embolization of pseudoaneurysms caused by gluteal stab injuries

Purpose

To retrospectively review the outcomes of 21 patients with stab wounds to the gluteal region who underwent embolization for pseudoaneurysms causing active bleeding.

Materials and methods

Between 1997 and 2007, 3 superior gluteal artery, 2 inferior gluteal artery and 16 deep femoral artery muscular branch pseudoaneurysms detected by digital subtraction angiography were selectively catheterized with diagnostic catheters with hydrophilic coating and embolized with pushable springcoils. 17 of the 21 pseudoaneurysms were located in a distal end of an artery where outflow vessels could not be depicted. The other 4 lesions were side wall injuries which required the placement of coils distal and proximal to the injury site.

Results

Embolization was successful in controlling the bleeding in all of the patients. 16 patients required 1 or 2 coils, 4 patients required 3 coils and 1 patient required 5 coils. 2 patients had femoral puncture site hematomas which resolved spontaneously. 2 patients required surgical evacuation of large gluteal hematomas following the embolization because of symptoms second to mass effect. There were no procedure related major complications or mortality.

Conclusions

Our experience demonstrates that pushable coil embolization is a relatively simple, effective and economic method for the embolization of pseudoaneurysms caused by penetrating gluteal injuries. Experimenting with other embolization materials does not seem to be justified.     

Traumatic pulmonary artery pseudoaneurysm

Traumatic pulmonary artery pseudoaneurysm is an uncommon cause of a solitary nodule on a chest radiograph. Consideration of this abnormality is important as the lesion can cause fatal hemorrhage. We report a patient with a traumatic segmental pulmonary artery pseudoaneurysm detected by computed tomography and confirmed by intravenous digital subtraction angiography.     

Inferior epigastric artery pseudoaneurysm: ultrasound diagnosis and treatment with percutaneous thrombin

A case of a pseudoaneurysm arising from the inferior epigastric artery in a patient presenting with a rectus sheath haematoma is reported. The pseudoaneurysm was successfully treated by percutaneous injection of human thrombin.     

Evaluation of transcatheter arterial embolization with coaxial microcatheter and micro-coil for vascular lesions]

Transcatheter arterial embolization using a coaxial microcatheter and micro-coil was performed in eight patients with vascular lesions; one each with aneurysm of the basilar artery, cerebellar artery, and pancreatic artery, pseudoaneurysm of the common hepatic artery, gastroduodenal artery, and gluteal artery, carotid-cavernous fistula, and thoracic paraspinal arteriovenous malformation. Complete occlusion was achieved in five patients with aneurysm and pseudoaneurysm by occluding the aneurysmal cavity and/or the orifice. A patient with recurrent carotid-cavernous fistula was also completely embolized. A case of basilar artery aneurysm resulted in partial occlusion because the posterior cerebral artery originated from the aneurysm. The unsatisfactory result in a case of paraspinal AVM was due to its wide extension with multiple feeding arteries. No apparent complication was seen. In conclusion, super-selective arterial embolization therapy with coaxial microcatheter and micro-coils was found to be a useful method for vascular lesions that would have been technically difficult to embolize with the standard catheter and coils.     

Preoperative angiographic landmarks of the gluteal muscle regions using Patent Blue V]

Use of a gluteus musculocutaneous flap is the most reliable technique for surgical repair of sacral ulcers. Surgery could be ideally performed when the flap is designed using only the upper or the lower half of the glutens maximus muscle depending on the superior gluteal artery or the inferior gluteal artery, respectively. The authors have developed a technique for preoperative demonstration of the vascular supply to both muscle and overlying skin from a single gluteal artery using superselective catheterization and arterial administration of a dye (Patent Blue V). This technique facilitates the surgical procedure but assessment of its usefulness will require further evaluation.     

Subclavian Artery Occlusion and Pseudoaneurysm Caused by Lung Apex Mucormycosis: Successful Treatment with Transcatheter Embolization

Subclavian artery pseudoaneurysm and occlusion in young patients are usually post-traumatic. We report the case of a 33-year-old diabetic woman with subclavian artery occlusion and pseudoaneurysm formation caused by pulmonary mucormycosis infection. The patient presented with diabetic ketoacidosis, Horner’s syndrome, and absent left arm pulses. A cystic lesion of the left lung apex was found by imaging, was surgically resected, and was histologically diagnosed as mucormycosis infection. Magnetic resonance angiography depicted a left subclavian artery pseudoaneurysm and occlusion adjacent to the mucormycosis lesion. To protect against thromboembolic complications and rupture, the pseudoaneurysm was embolized with coils. The patient is clinically well 1 year after the intervention with no perfusion of the pseudoaneurysm.