Coil Embolization with Side-Holed Catheter to Preserve Peripheral Flow for Visceral Artery Pseudoaneurysm: An Experimental Study in Swine

Evaluation of a Hydrogel Liquid Embolic in a Porcine Mesenteric Hemorrhage Model

PURPOSE

To evaluate a new liquid embolic in a porcine mesenteric artery hemorrhage model.

METHODS AND MATERIALS

An anticoagulated porcine mesenteric artery hemorrhage model was created using a transarterial approach. Arterial hemorrhage was the result of aspiration needle punctures and simultaneous radiofrequency (RF) current application. Ten mesenteric arteries injured in eight swine were treated. The hydrogel liquid embolic under investigation, an aqueous-based and in situ polymerizing liquid embolic, was used to treat actively bleeding sites. At seven days, confirmation angiography was performed followed by necropsy.

RESULTS

The mesenteric arterial injuries produced persistent and angiographically visible hemorrhage prior to initiating embolic therapy. Arteriovenous fistulas were observed in four cases. Embolization led to hemostasis in 10/10 bleeds (100%). The mean embolic delivery time was 5.3 minutes (range 1-15 minutes) with a mean embolic volume of 2.9mL (range 0.8-5.2 mL) delivered to achieve hemostasis. Notably, 40% of the treatments embolized the injury in the artery at the treatment site while leaving the native arterial lumen patent for the seven day term of survival. All animals survived with no clinical evidence of hemorrhage through seven days. Necropsy did not find evidence of ischemia within bowel, liver and lung.

CONCLUSION

A new hydrogel liquid embolic was found to safely obtain acute and durable hemostasis in an animal model of persistent angiographic hemorrhage.

Endovascular Treatment of Hepatic Artery Pseudoaneurysm after Pancreaticoduodenectomy: Risk Factors Associated with Mortality and Complications

PURPOSE

To evaluate risk factors predicting death and complications of primary therapy for hepatic and gastric duodenal artery pseudoaneurysms following endovascular treatment (EVT) after pancreaticoduodenectomy (PD).

MATERIALS AND METHODS

Between April 2004 and December 2014, 28 patients (mean age, 64.7 y) with post-PD hemorrhage underwent EVT. Prevention of hepatic artery blockage via stents or side-holed catheter grafts was stratified in cases without a replaced hepatic artery. Mortality and major hepatic complications following EVT were evaluated according to age; sex; surgery-EVT interval; presence of portal vein stenosis, shock, and coagulopathy at EVT onset; and post-EVT angiographic findings.

RESULTS

All hemorrhages were successfully treated with microcoils (n = 17; 61%), covered stents (n = 1; 3%), bare stent-assisted coil embolization (n = 5; 18%), or catheter grafts with coil embolization (n = 5; 18%). Hepatic arterial flow was observed after EVT in 18 patients (64%). Mortality and major hepatic complication rates were 28.6% and 32.1%, respectively. Hemorrhagic shock and coagulopathy at EVT onset (n = 8 each; odds ratio [OR], 27; 95% confidence interval [CI], 3.1-235.7; P < .01) were significantly associated with mortality. Coagulopathy at EVT onset (adjusted OR [aOR], 48.1; 95% CI, 3.2-2,931), portal vein stenosis (n = 16; aOR, 16.9; 95% CI, 1.3-721.9), and no visualization of hepatopetal flow through the hepatic arteries (n = 10; aOR, 29.5; 95% CI, 2.1-1,477) were significantly associated with major hepatic complications.

CONCLUSIONS

EVT should be performed as soon as possible before the development of shock or coagulopathy. Hepatic arterial flow visualization decreases major hepatic complications.