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Case Reports
. 2015 Aug 7;1(3):211-213.
doi: 10.1016/j.jvsc.2015.06.001. eCollection 2015 Sep.

Ultrasound-guided percutaneous thrombin for the management of superior mesenteric artery pseudoaneurysm

Patrick Casey  1 , Ambareen Kausar  1 , Duncan Gavan  2 , Neil Wilde  2
Affiliations
Case Reports

Ultrasound-guided percutaneous thrombin for the management of superior mesenteric artery pseudoaneurysm

Patrick Casey et al. J Vasc Surg Cases. .

Abstract

Visceral aneurysms are a well-recognized and potentially fatal occurrence in the event of rupture. Endovascular occlusion using stent grafting or embolization is often favorable over high-risk open surgical repair. However, interventional mesenteric angiography may not always be feasible or successful. We present an emergency case of successful occlusion of a large peripancreatic pseudoaneurysm using a single percutaneous injection of thrombin under ultrasound guidance alone after both laparotomy and mesenteric angiography had failed to identify and control bleeding. In this case and review of the current evidence, we propose an effective alternative first-line treatment strategy in these complex patients.

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Figures

Fig 1
Fig 1
Arterial-phase axial computed tomography (CT) scan demonstrating 5.6-cm aneurysm arising from a branch of the superior mesenteric artery.
Fig 2
Fig 2
Ultrasound image showing absence of Doppler flow in the thrombosed aneurysm sac 3 days after thrombin injection.
Fig 3
Fig 3
Coronal (a) and axial (b) arterial-phase computed tomography (CT) images 1 month after thrombin injection. The aneurysm sac has reduced in size to 4.4 cm and remains occluded. The 8-month follow-up CT scan shows virtually complete resolution of the aneurysm sac on coronal (c) and axial (d) views.
See this image and copyright information in PMC

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