Aljutaili Hamad, Altun Izzet, Toursavadkohi Shahab A, Nezami Nariman
Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, N2W79A, Baltimore, MD, 21201, USA.
Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
CVIR Endovasc. 2023 Mar 25;6(1):17. doi: 10.1186/s42155-023-00367-w.
Antegrade access through the origin of the internal iliac and direct percutaneous access under cross-sectional imaging guidance are commonly used for embolization of internal iliac artery aneurysms, pseudoaneurysms, or endoleaks. Here, we report superior gluteal artery retrograde access to treat internal iliac artery mycotic pseudoaneurysm in a patient with failed direct percutaneous access.
We present a 65-year-old female with a history of diverticulitis and sigmoidectomy. Post-sigmoidectomy course was complicated by left common iliac artery (CIA) iatrogenic injury which required surgical ligation of the left CIA and graft placement. However, the graft was subsequently resection due to infection. Follow up CT imaging showed a 6 cm mycotic pseudoaneurysm (PSA) of the left internal iliac artery. Initially, the PSA sac was directly accessed and embolized under direct CT-guidance using Onyx. However, enlargement of the PSA sac was noted on one week follow-up CT images. Then, superior gluteal artery was accessed under ultrasound guidance, and the PSA sac and feeding vessels were re-embolized with coil and Onyx under fluoroscopy.
Retrograde access through superior gluteal artery is a feasible and safe approach to embolize internal iliac aneurysms, pseudoaneurysms, or endoleaks, when the antegrade or direct percutaneous access is limited.
经髂内动脉起始部的顺行入路以及在横断面成像引导下的直接经皮入路常用于髂内动脉瘤、假性动脉瘤或内漏的栓塞治疗。在此，我们报告了在直接经皮入路失败的患者中，采用臀上动脉逆行入路治疗髂内动脉霉菌性假性动脉瘤的情况。
我们介绍了一位65岁的女性，有憩室炎和乙状结肠切除术病史。乙状结肠切除术后出现并发症，左侧髂总动脉发生医源性损伤，需要对左侧髂总动脉进行手术结扎并置入移植物。然而，移植物随后因感染而被切除。后续CT成像显示左侧髂内动脉有一个6厘米的霉菌性假性动脉瘤。最初，在直接CT引导下直接进入假性动脉瘤囊并使用Onyx进行栓塞。然而，在一周后的随访CT图像上发现假性动脉瘤囊增大。然后，在超声引导下进入臀上动脉，并在荧光透视下用弹簧圈和Onyx对假性动脉瘤囊和供血血管再次进行栓塞。
当顺行或直接经皮入路受限，通过臀上动脉逆行入路栓塞髂内动脉瘤、假性动脉瘤或内漏是一种可行且安全的方法。
