Explore the vast range of titles available.

Abstract BACKGROUND There is a paucity of literature regarding treatment options for extracranial pseudoaneurysms of the internal carotid artery (ICA). To date, Pipeline Embolization Device (PED; Medtronic Inc) use for the treatment of extracranial pseudoaneurysms of the ICA has only been reported from single-center case series. OBJECTIVE To evaluate the safety and efficacy of PED for the treatment of extracranial ICA pseudoaneurysms. METHODS This is a multicenter retrospective study involving 6 high-volume tertiary academic institutions in the United States. We analyzed patients with extracranial ICA pseudoaneurysms treated with PED between January 1, 2011, and January 1, 2019. Clinical assessment was performed pre- and postintervention using the modified Rankin Scale (mRS) and National Institution of Health Stroke Scale (NIHSS) at a minimum of 4-mo follow-up. RESULTS A total of 28 pseudoaneurysms with a mean diameter of 17.7 mm (range: 4.1-52.5 mm) were treated with PED in 24 patients at 6 participating centers. The mean age was 52.1 yr (17-73) ± 14.3 with 14 females and 10 males. At a mean of 21-mo (range 4-66 mo) follow-up, complete occlusion was achieved in 89% (n = 25/28), with near-complete occlusion (>90% occlusion) in the remainder. There were no periprocedural complications. Postprocedure NIHSS was 0 in 88% (n = 21/24) and 1 in 12% (n = 3/24) of patients, and mRS was 0 in 83% (n = 20/24) and 1 in 17% (n = 4/24) of patients. CONCLUSION The treatment of extracranial ICA pseudoaneurysms with PED is safe and effective in selected patients. Randomized controlled trials and prospective cohort studies are needed to establish the role of flow diversion for ICA pseudoaneurysms. Graphical Abstract Graphical Abstract

Management of postcatheterization femoral artery pseudoaneurysm (FAP) is problematic. Ultrasound-guided compression (UGC) is painful and cumbersome. Thrombin injection is costly and may cause thromboembolism. Ultrasound-guided para-aneurysmal saline injection (PASI) has been described but was never compared against other treatment methods of FAP. We aimed at comparing the success rate and complications of PASI versus UGC. We randomly assigned 80 patients with postcatheterization FAPs to either UGC (40 patients) or PASI (40 patients). We compared the 2 procedures regarding successful obliteration of the FAP, incidence of vasovagal attacks, procedure time, discontinuation of antiplatelet and/or anticoagulants, and the Doppler waveform in the ipsilateral pedal arteries at the end of the procedure. There was no significant difference between patients in both groups regarding clinical and vascular duplex data. The mean durations of UGC and PASI procedures were 58.14 ± 28.45 and 30.33 ± 8.56 minutes, respectively (p = 0.045). Vasovagal attacks were reported in 10 (25%) and 2 patients (5%) treated with UGC and PASI, respectively (p = 0.05). All patients in both groups had triphasic Doppler waveform in the infrapopliteal arteries before and after the procedure. The primary and final success rates were 75%, 92.5%, 87.5%, and 95% for UGC and PASI, respectively (p = 0.43). In successfully treated patients, there was no reperfusion of the FAP in the follow-up studies (days 1 and 7) in both groups. In conclusion, ultrasound-guided PASI is an effective method for the treatment of FAP. Compared with UGC, PASI is faster, less likely to cause vasovagal reactions, and can be more convenient to patients and physicians.

Direct manual compression without concurrent technical surveillance may be a simple alternative to both ultrasound guided compression repair (UGCR) and ultrasound guided thrombin injection. Since this simple method of manual compression repair (MCR) proved to be effective in a preliminary study, we conducted a prospective, randomised trial comparing MCR versus UGCR. 1 PATIENTS AND METHODS From September 1997 to January 2000 Duplex ultrasonography was performed in all patients with clinically suspected disease in the groin after cardiac and peripheral arterial catheterisation. Since it requires less technical equipment than both UGCR and ultrasound guided percutaneous thrombin injection, MCR is more cost effective than the other two methods.

Management strategies for pseudoaneurysm rupture after pancreatic resection have not yet been firmly established due to its low incidence and effects of environmental variability among centers. This study aimed to provide a basis for treatment strategy improvement. Clinical features and outcomes of 29 patients who experienced pseudoaneurysm formation or rupture following pancreatic resection were retrospectively reviewed. The incidence of pseudoaneurysm formation was 2.8%. In 28 of 29 patients, pseudoaneurysm was identified via emergent dynamic computed tomography (CT). The rates of complete cessation of bleeding by interventional radiology (IVR) and surgical intervention were 88% and 100%, respectively. Mortality rate was 13.8%. Four patients treated by IVR died, including three of massive bleeding and one of liver failure. Patients with suspected pseudoaneurysm rupture after pancreatic resection should undergo immediate CT. Open surgery is preferable for patients with incomplete hemostasis by IVR or those who cannot immediately undergo IVR, however, IVR is an effective alternative.

Background Thalamoperforating artery (TPA) pseudoaneurysms are relatively uncommon and often pose significant challenges in detection through vascular examination. Furthermore, their management, particularly via endovascular therapy, is complex and demanding. This article presents a case study of a patient diagnosed with an acute TPA pseudoaneurysm, highlighting its rarity and the intricacies involved in its treatment. Case presentation A 49-year-old male was admitted to our hospital presentingwith headache and vomiting, with a medical history notable for hypertension and previous cardiac surgery. Neurological examination was remarkable solely for neck stiffness. Initially, imaging revealed an aneurysm of the left internal carotid artery (ICA) concurrent with the first episode of subarachnoid hemorrhage, with no other aneurysms detected. On the third day post-embolization of the left ICA aneurysm, recurrent subarachnoid hemorrhag prompted emergency angiography, which identified a new pseudoaneurysm of the TPA. Subsequent endovascular treatment with electrocoagulation resulted in a favorable recovery, and there has been no recurrnce of the aneurysm. Conclusions TPA pseudoaneurysm is an exceedingly rare condition that often eludes detection during initial vascular imaging via angiography, necessitating repeated angiographic examinations. The management of TPA pseudoaneurysm presents significant. challenges due to its rarity. Notably, the application of electrocoagulation as a treatment modality for TPA pseudoaneurysm has not been documented in existing literature. Electrocoagulation may serve as a viable alternative when microcatheter navigation into the aneurysm is not feasible. however, attention must be given to its potential limitations. The long-term efficacy and durability of this technique warrant careful monitoring through ongoing follow-up.

SCAD is now recognized as an important cause of ACS in women, and its treatment is generally based on conservative therapy leading to complete cure. However, complete cure is not systematic, and data are lacking to identify patients at risk of malignant progression and to define the best therapeutic strategy.A 36-year-old woman with STEMI on SCAD extending from the LM to the middle LAD and circumflex artery, evolving under medical treatment to a large LM pseudo aneurysm. After CT evaluation and IVUS measurement, the patient underwent pseudo aneurysm exclusion by implantation of two overlapping DES on his collar. The choice of conservative treatment in the initial phase, given the extension of SCAD to all left coronary arteries, and the management of this voluminous LM pseudo aneurysm by implantation of two overlapping DES rather than by a covered stent or coil embolization, can be discussed here. Learning points • The evolution of a SCAD under conservative treatment is not systematically complete cure and may result in a voluminous coronary pseudo aneurysm. • Excluding a coronary pseudo aneurysm by two overlapping DES on its collar is a treatment option worth considering. • IVUS enables precise measurement of the pseudo aneurysm to guide angioplasty.

This systematic review and meta-analysis investigated the clinical characteristics of patients with gastroduodenal artery aneurysm (GDA), identified risk factors associated with poor clinical outcomes, and elucidated potential differences between various GDA etiologies. A systematic literature search was conducted from January 2000 to October 2023 in the PubMed, EMBASE, and Google Scholar databases. The analysis focused on extracting data regarding clinical presentations, diagnostic modalities, and patient outcomes. This meta-analysis included data from 224 patients derived from 207 case reports spanning 47 countries over a 23-year period. The majority of patients presented with comorbidity (85.3%) and had a predisposing factor for GDA (71.9%). The diagnostic accuracy of the three most common diagnostic investigations-namely angiography, abdominal computed tomography, and ultrasound-was 100.0%, 86.2%, and 59.6%, respectively. Transarterial embolization (75.0%) and surgery (24.1%) were the two most common therapeutic approaches. Emergent treatment for GDA was necessary in 31.7% of patients. Notably, hemostasis was achieved after the initial treatment attempt in 82.6% of patients. The in-hospital mortality rate was 6.7%, with complications occurring in 16.1% of cases. A higher percentage of patients with a complicated hospital course were subjected to observation management and presented with shock during hospitalization. Patients with GDA often have comorbidities and predisposing factors. Clinical presentations of GDA were found to include abdominal pain, hemorrhage, and obstruction of peripheral structures in the vicinity of the gastroduodenal artery. Splanchnic artery angiography and abdominal computed tomography are recognized as the most accurate tools for diagnosing GDA. Endovascular management is the mainstay treatment approach for most patients and have a high rate of hemostasis success during the initial intervention. Surgical intervention is also a practical treatment. Conservative management with observation management may lead to a complicated hospital course, highlighting the potential benefit of aggressive treatment strategies for GDA. Patients with pancreatitis exhibited more comorbidities, predisposing factors, and a broader spectrum of clinical manifestations compared to those without pancreatitis. However, the in-hospital mortality rate was lower in the pancreatitis group, likely due to the younger age of the patients and the more prominent clinical presentations, which prompted earlier and more extensive diagnostic imaging studies.

Objective Pulmonary artery pseudoaneurysms (PAPs) are rare, but important and treatable cause of massive haemoptysis. Minimal data exists on their interventional radiology management due to their rarity, especially direct percutaneous injection. Here, we report our experience of direct percutaneous management of such pseudoaneurysms. Methods Data of patients presenting to our department from January 2014 to November 2019 was retrospectively analysed, who presented with massive haemoptysis, and CT angiography positive for pulmonary artery pseudoaneurysms. Only patients treated with direct percutaneous intervention were included. Twelve patients who were managed endovascularly were excluded from the study. Observations were tabulated under age, sex, underlying pathology, lobe involved, number and size of the pseudoaneurysm, imaging guidance and embolising agent. Technical and clinical success and complications were then analysed. Results Twenty-nine pseudoaneurysms were treated in 27 patients with a mean age of 41.4 years. The most common underlying aetiology was tuberculosis (85.1%), with the most common location being bilateral upper lobes (31% each). CT guidance was the most frequently used imaging guidance (26/29). N-butyl cyanoacrylate (NBCA) glue mixture was used in 79.3% and reconstituted thrombin in the remaining 20.7% pseudoaneurysms. Complete technical and clinical success rates were 93.1% and 88.9% respectively. No major complications were seen except for development of significant pneumothorax in one patient. Conclusion Pulmonary pseudoaneurysms are rare but fatal cause for massive haemoptysis. Interventional radiology management via direct percutaneous embolisation is a safe and minimally invasive treatment measure in selective patients, with successful outcomes and minimal complication and recurrence rates. Key Points • Pulmonary artery pseudoaneurysms are rare but important and treatable cause of massive haemoptysis. • This study shows the advantages of percutaneous management of these pseudoaneurysms as an alternate to endovascular embolisation, in case endovascular embolisation is not feasible or practical. • It is a safe and minimally invasive treatment, with technical success of 93.1% and clinical success of 88.9% in this study.

Intercostal artery pseudoaneurysms are rare vascular emergencies that are most commonly triggered by trauma or iatrogenic injury. Computed tomography angiography (CTA) is essential for prompt diagnosis, and endovascular embolization is the preferred treatment. We present a rare case of spontaneous rupture of an intercostal artery pseudoaneurysm that manifested initially only as nonspecific upper abdominal pain. The patient expired following unsuccessful resuscitation before intervention. We discuss the cause and review the literature.

STAT3-hyper IgE syndrome (STAT3-HIES) is a primary immunodeficiency disorder caused by dominant-negative mutations in STAT3 , leading to defects in Th17 cell differentiation, immune regulation, and tissue repair. Patients are susceptible to recurrent infections and vascular abnormalities, such as vasculopathy and pseudoaneurysms. While involvement of cerebral, bronchial, and coronary arteries has been reported, hepatic artery involvement is rare. We describe a 25-year-old woman with genetically confirmed STAT3-HIES who presented with biliary hemorrhage secondary to a ruptured hepatic pseudoaneurysm. Emergency transcatheter arterial embolization successfully controlled the hemorrhage, and the patient was discharged without complications. Systemic vascular screening revealed an asymptomatic right coronary artery dilation, necessitating medical management with statin therapy. This case highlights hepatic pseudoaneurysm as a rare but life-threatening vascular complication in STAT3-HIES. Given the potential for multi-organ vasculopathy, systemic vascular screening by contrast-enhanced CT or MRI is crucial for early detection and management. Further research is needed to elucidate the mechanisms underlying vasculopathy in STAT3-HIES and establish optimal screening strategies to improve patient outcomes.