Endovascular coiling of a cystic artery pseudoaneurysm скачать в хорошем качестве

Endovascular coiling of a cystic artery pseudoaneurysm

Endovascular coiling of a cystic artery pseudoaneurysm in a patient with acute calculous cholecystitis. A 54 years old woman, presented with history of upper abdominal pain since 4 months, increased since last 3 days. She was hypertensive, controlled on oral medications, and no prior history of surgery or any other significant medical history. An ultrasound abdomen study, outside our institute, was reported to have multiple gall bladder calculi with ‘vague soft tissue’ in region of porta. The patient was referred initially for contrast CT scan to our department for evaluation. It showed a dense contrast filled structure 21x18 mm in size at the neck of the gall bladder. Surrounding it was nonenhancing soft tissue. The gall bladder itself showed mild edematous wall and was partially distended. No radiodense calculus was seen. A diagnosis of a pseudoaneurysm in relation to the GB neck was made. Patient was then taken up for catheter angiography and coiling. Selective angiography study of celiac, superior and inferior mesenteric arteries was done, following which superselective study of the cystic artery was done with a 2.7 F Progreat microcatheter (Terumo Medical Corporation, Somerset, NJ, USA) The hepatic artery arose from superior mesenteric artery in this case. Study showed a small pseudoaneurysm arising from the cystic artery just after its origin from the right hepatic artery. Then a Hilal 0.018 inch coil 2 mm x2 cm (Cook medical, USA) was pushed at this stable position. The coil occluded the cystic artery from its ostium. No filling of the pseudoaneurym was seen in postprocedure check angiogram. The patient was put on intravenous antibiotics and later sent home after 3 days. Her symptoms resolved completely. She underwent interval cholecystectomy subsequently and is living a healthy life since then. | AIIMS Patna | Interventional Radiology