BACKGROUND Aortic adverse remodeling remains a critical complication following thoracic endovascular aortic repair(TEVAR)for Stanford type B aortic dissection(TBAD),significantly impacting long-term survival.Accurate ...BACKGROUND Aortic adverse remodeling remains a critical complication following thoracic endovascular aortic repair(TEVAR)for Stanford type B aortic dissection(TBAD),significantly impacting long-term survival.Accurate risk prediction is essential for optimized clinical management.AIM To develop and validate a logistic regression-based risk prediction model for aortic adverse remodeling following TEVAR in patients with TBAD.METHODS This retrospective observational cohort study analyzed 140 TBAD patients undergoing TEVAR at a tertiary center(2019–2024).Based on European guidelines,patients were categorized into adverse remodeling(aortic growth rate>2.9 mm/year,n=45)and favorable remodeling groups(n=95).Comprehensive variables(clinical/imaging/surgical)were analyzed using multivariable logistic regression to develop a predictive model.Model performance was assessed via receiver operating characteristic-area under the curve(AUC)and Hosmer-Lemeshow tests.RESULTS Multivariable analysis identified several strong independent predictors of negative aortic remodeling.Larger false lumen diameter at the primary entry tear[odds ratio(OR):1.561,95%CI:1.197–2.035;P=0.001]and patency of the false lumen(OR:5.639,95%CI:4.372-8.181;P=0.004)were significant risk factors.False lumen involvement extending to the thoracoabdominal aorta was identified as the strongest predictor,significantly increasing the risk of adverse remodeling(OR:11.751,95%CI:9.841-15.612;P=0.001).Conversely,false lumen involvement confined to the thoracic aorta demonstrated a significant protective effect(OR:0.925,95%CI:0.614–0.831;P=0.015).The prediction model exhibited excellent discrimination(AUC=0.968)and calibration(Hosmer-Lemeshow P=0.824).CONCLUSION This validated risk prediction model identifies aortic adverse remodeling with high accuracy using routinely available clinical parameters.False lumen involvement thoracoabdominal aorta is the strongest predictor(11.751-fold increased risk).The tool enables preoperative risk stratification to guide tailored TEVAR strategies and improve long-term outcomes.展开更多
Minimally invasive interventional surgery techniques using guidewire-based catheters are widely adopted to treat vascular diseases.However,commonly used interventional catheters lack active guidance.The use of guidewi...Minimally invasive interventional surgery techniques using guidewire-based catheters are widely adopted to treat vascular diseases.However,commonly used interventional catheters lack active guidance.The use of guidewires is associated with risks,including increased exposure to X-rays and potential vascular damage during withdrawal from complex vessels.Herein,we developed sub-millimeter microtubular ionic actuators(0.6-0.8 mm outer diameter)integrated into steerable interventional catheters.These actuators can generate large deformations(>10 mm)under 7 V direct current due to enhanced ion migration,enabling precise navigation without the need for guidewires.The designed catheters achieved active bending and accurate positioning in complex arterial vascular branches within a human model.They were also able to navigate within different arterial locations(e.g.,the innominate,subclavian,and carotid arteries)in pigs without the use of guidewires,and even access the ventricle and deliver contrast medium,indicating their great potential for future endovascular therapy.展开更多
BACKGROUND Delayed post-pancreatectomy hemorrhage(PPH)is life-threatening,and endovascular interventions show promise.This retrospective study aimed to evaluate endovascular treatment outcomes for delayed PPH and iden...BACKGROUND Delayed post-pancreatectomy hemorrhage(PPH)is life-threatening,and endovascular interventions show promise.This retrospective study aimed to evaluate endovascular treatment outcomes for delayed PPH and identify mortality risk factors.AIM To conduct a single-center retrospective study of 88 patients with delayed PPH to systematically evaluate the clinical efficacy of endovascular treatment,identify independent risk factors for six-month mortality,and propose and validate a predictive model for individualized management of high-risk patients.METHODS This retrospective analysis included 88 patients with delayed PPH treated by endovascular intervention.Patients were stratified into survival(n=64)and mortality(n=24)groups.Clinical and procedural variables were assessed using univariate and multivariate logistic regression.Significant predictors were incorporated into a prognostic nomogram.Model performance was assessed through discrimination(area under the receiver operating characteristic curve),calibration,and decision curve analysis.RESULTS Technical and clinical success rates were 92.0%and 60.2%,respectively.The overall six-month mortality rate was 27.3%(24/88).Independent predictors of mortality included advanced age,prolonged operative time,shorter hospital stay,intra-abdominal infection,coagulation dysfunction,common hepatic artery bleeding,and failure to achieve clinical success.The nomogram demonstrated excellent discrimination(area under the receiver operating characteristic curve=0.943),with good calibration and favorable net benefit on decision curve analysis.CONCLUSION We proposed and validated a predictive nomogram for six-month mortality following endovascular treatment for delayed PPH.The model facilitates individualized risk stratification and may guide clinical decision-making.Early identification of high-risk patients-particularly older individuals or those with infection or coagulopathy-and prompt,personalized intervention may improve outcomes in this high-risk population.展开更多
BACKGROUND Intracranial blister-like microaneurysms are an extremely rare disease.Rupture of intracranial aneurysms can lead to subarachnoid hemorrhage(SAH).Patients with SAH may experience severe neurological symptom...BACKGROUND Intracranial blister-like microaneurysms are an extremely rare disease.Rupture of intracranial aneurysms can lead to subarachnoid hemorrhage(SAH).Patients with SAH may experience severe neurological symptoms,including severe headache,nausea,vomiting,transient or persistent loss of consciousness,limb weakness,and blurred vision.Ruptured aneurysms should be surgically treated as soon as possible.Intravascular electrocoagulation is becoming a promising treatment method for intracranial blister-like microaneurysms.The short-term follow-up results demonstrated that this method is safe and effective.This article presents a case of endovascular electrocoagulation for the treatment of a blisterlike microaneurysm.CASE SUMMARY This article reports the case of 71-year-old female patient with an intracranial aneurysm.The patient experienced a sudden headache with vomiting for 3 hours.Brain computed tomography(CT)scan showed a subarachnoid hemorrhage.She was diagnosed with rupture of an aneurysm and subarachnoid hemorrhage.The aneurysm was located in the choroidal segment of the right internal carotid artery.The size of the aneurysm was 2.00 mm×1.80 mm×1.97 mm,and the neck of the aneurysm was less than 0.5 mm wide.We successfully treated this aneurysm with endovascular electrocoagulation,and the patient was safely returned to the ward and discharged after subsequent supportive treatment.CT angiography reexamination 3 months after surgery revealed no contrast agent extravasation in the original lesion,with a good prognosis.CONCLUSION Endovascular electrocoagulation is an effective and safe method for the treatment of intracranial blister-like microaneurysms.展开更多
Nature-inspired designs have increasingly influenced biomedical engineering by providing superior biomechanical performance and structural stability.In this study,the diabolical ironclad beetle elytra structure was ap...Nature-inspired designs have increasingly influenced biomedical engineering by providing superior biomechanical performance and structural stability.In this study,the diabolical ironclad beetle elytra structure was applied to stent strut designs and thoroughly evaluated through various computational simulations to assess their potential to enhance the mechanical performance of WE43 magnesium alloy stents.Connected elliptical structures with a vertical-to-horizontal length ratio of 1:1.8 were incorporated in varying numbers and then compared to conventional laser-cut stents using 3-point bending,crush,crimping,and expansion tests,internal carotid artery insertion simulations,and computational fluid dynamics analyses.The results demonstrated that the biomimetic stents exhibited significantly improved stress distribution and reduced applied stress while maintaining hemodynamic stability.Computational fluid dynamics simulations further confirmed that the biomimetic could reduce wall shear stress and improve blood flow,thereby potentially minimizing the risk of restenosis and thrombosis.These findings suggest that diabolical ironclad beetle-inspired stent structures may offer enhanced biomechanical performance and clinical safety in magnesium-based endovascular interventions.展开更多
BACKGROUND Sex disparities in clinical outcomes following thoracic endovascular aortic repair(TEVAR)for acute complicated type B aortic dissection(TBAD)are not well understood.AIM To evaluates the impact of sex on pri...BACKGROUND Sex disparities in clinical outcomes following thoracic endovascular aortic repair(TEVAR)for acute complicated type B aortic dissection(TBAD)are not well understood.AIM To evaluates the impact of sex on primary and secondary outcomes by comparing male and female cohorts undergoing TEVAR.METHODS A systematic search of PubMed,EMBASE,Cochrane Library,and ScienceDirect identified five studies involving 2572 patients(1153 males and 1419 females).The primary outcome was hospital mortality.Secondary outcomes included reintervention rates,acute kidney injury(AKI),ischemic stroke,limb ischemia,and spinal cord ischemia.Odds ratios(OR)with 95%confidence intervals(CI)were calculated using a random-effects model.Heterogeneity was assessed using the I²statistic.RESULTS The primary outcome showed no significant difference between males and females for hospital mortality(OR:1.13,95%CI:0.81-1.59,P=0.47,I2=0).Among secondary outcomes,males had a significantly higher risk of AKI(OR:1.55,95%CI:1.21-2.00,P=0.0006,I²=0).No differences were observed for reintervention rates,ischemic stroke,limb ischemia,or spinal cord ischemia.CONCLUSION Male patients undergoing TEVAR for complicated TBAD are at increased risk of AKI but show comparable outcomes to females for mortality,ischemic events,reintervention,and other complications.Future research should explore mechanisms and strategies to optimize outcomes.展开更多
BACKGROUND Descending thoracic aortic aneurysms are dangerous and have to be treated quickly.The primary treatment methods are thoracic endovascular aortic repair(TEVAR)and open surgical repair(OSR).The comparative ef...BACKGROUND Descending thoracic aortic aneurysms are dangerous and have to be treated quickly.The primary treatment methods are thoracic endovascular aortic repair(TEVAR)and open surgical repair(OSR).The comparative effectiveness and safety of TEVAR and OSR were evaluated in this meta-analysis,focusing on perioperative and long-term outcomes.AIM To compare and contrast the efficacy and safety of TEVAR vs OSR in the treatment of descending thoracic aortic aneurysms.This study aims to assess both perioperative and long-term outcomes through a systematic review and metaanalysis.METHODS A comprehensive search of PubMed,EMBASE,and Cochrane was conducted from inception to January 2025.Baseline characteristics and outcomes were evaluated.Odds ratios(OR)for dichotomous data and mean differences for continuous data with 95%confidence intervals(CI)were analyzed using random-effects models.RESULTS A meta-analysis of 21 studies involving 29465 patients(8261 TEVAR;21204 OR)showed TEVAR associated with lower operative mortality(OR=0.60,95%CI:0.42-0.85,P=0.004),shorter intensive care unit(-2.94 days,95%CI:-4.76 to-1.12,P=0.002)and hospital stays(-7.35 days,95%CI:-10.54 to-4.17,P<0.00001),and reduced rates of paraplegia(OR=0.44,95%CI:0.27-0.73,P=0.002),spinal ischemia(OR=0.30,95%CI:0.16-0.56,P=0.0002),renal failure(OR=0.29,95%CI:0.14-0.61,P=0.001),and wound infections(OR=0.28,95%CI:0.13-0.61,P=0.001).However,TEVAR had higher rates of vascular complications.No significant differences were noted in 1-year and 5-year mortality rates,the rate of non-elective surgery,neurological complications,or stroke rates.CONCLUSION Compared to EVAR,TEVAR revealed lower operative mortality and better perioperative outcomes across all indicators,including hospital and intensive care unit stays,as well as fewer complications,except for those related to vascular problems.Mortality results were also similar in the long run;consequently,more research is required concerning the long-term durability.展开更多
BACKGROUND Peripheral endovascular intervention(PEVI)is performed using radiation.Radiation has deleterious health consequences for patients and operators.AIM To investigate the gender radiation disparities and proced...BACKGROUND Peripheral endovascular intervention(PEVI)is performed using radiation.Radiation has deleterious health consequences for patients and operators.AIM To investigate the gender radiation disparities and procedural outcomes in PEVI.METHODS A prospective observational study was performed in 186 consecutive patients(65±12 years)at an academic medical center from January 2019 to April 2020(mean follow-up of 3.9±3.6 months)comparing the gender radiation disparity and outcomes of PEVI(n=147 underwent intervention,79.0%).Groups were divided into women(n=99,53.2%)and men(n=87,48.4%).Primary endpoints included air kerma,dose area product(DAP),fluoroscopy time,and contrast use.Secondary endpoints included all-cause mortality,acute myocardial infarction,acute kidney injury,stroke,repeat revascularization,major adverse limb event,and the composite of complications.RESULTS Men showed increased DAP compared with women(15221.2±25858.5µGy×m^(2) vs 9251.7±9555.3µGy×m^(2),P=0.047),but no significant difference in air kerma or any other primary endpoints.In the secondary endpoints,no significant diffe-rence was found between gender.CONCLUSION Men had increased DAP indicating more radiation absorption in the exposed area.Gender outcomes showed no difference in complications.Thus,PEVI can be safely performed in men or women.展开更多
The virtual reality based motion simulation of the guide wire and the catheter inside specific vascular structures can benefit a lot for the endovascular intervention. A fast and well-performed collision cancellation ...The virtual reality based motion simulation of the guide wire and the catheter inside specific vascular structures can benefit a lot for the endovascular intervention. A fast and well-performed collision cancellation algorithm is proposed based on the geometric analysis and the angular propagation （AP）, and a 3-D real-time interactive system is developed for the motion simulation of the guide wire and the catheter inside the specific patient vascular. The guide wire or the catheter is modeled as the ＂multi-body＂ representation and properties are defined by its intrinsic characteristics. The motion of the guide wire or the catheter inside the vascular is guided by the collision detection and the collision cancellation algorithm. Finally, a relaxation procedure is used to achieve more realistic status. Experimental results show that the behavior of the guide wire or the catheter depends on the defined parameters. The real-time simulation can be achieved. The result shows that the simulation system is effective and promising.展开更多
Carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. Several classification schemes have described carotid cavernous sinus fistulas according to etiology, he...Carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. Several classification schemes have described carotid cavernous sinus fistulas according to etiology, hemodynamic features, or the angiographic arterial architecture. Increased pressure within the cavernous sinus appears to be the main factor in pathophysiology. The clinical features are related to size, exact location, and duration of the fistula, adequacy and route of venous drainage and the presence of arterial/venous collaterals. Noninvasive imaging (computed tomography, magnetic resonance, computed tomography angiography, magnetic resonance angiography, Doppler) is often used in the initial workup of a possible carotid cavernous sinus fistulas. Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of treatment for these lesions. The endovascular approach has evolved as the mainstay therapy for definitive treatment in situations including clinical emergencies. Conservative treatment, surgery and radiosurgery constitute other management options for these lesions.展开更多
AIM To evaluate the safety and efficacy of combined endovascular brachytherapy(EVBT),transarterial chemoembolization(TACE),and sorafenib to treat hepatocellular carcinoma(HCC) patients with main portal vein tumor thro...AIM To evaluate the safety and efficacy of combined endovascular brachytherapy(EVBT),transarterial chemoembolization(TACE),and sorafenib to treat hepatocellular carcinoma(HCC) patients with main portal vein tumor thrombus(MPVTT).METHODS This single-center retrospective study involved 68 patients with unresectable HCC or those who were unfit for liver transplantation and percutaneous frequency ablation according to the BCLC classification. All patients had Child-Pugh classification grade A or B,Eastern Cooperative Oncology Group(ECOG)performance status of 0-2,and MPVTT. The patients received either EVBT with stent placement,TACE,and sorafenib(group A,n = 37),or TACE with sorafenib(group B,n = 31). The time to progression(TTP) and overall survival(OS) were evaluated by propensity score analysis.RESULTS In the entire cohort,the 6-,12-,and 24-mo survival rates were 88.9%,54.3%,and 14.1% in group A,and 45.8%,0%,and 0% in group B,respectively(P < 0.001). The median TTP and OS were significantly longer in group A than group B(TTP: 9.0 mo vs 3.4 mo,P < 0.001; OS: 12.3 mo vs 5.2 mo,P < 0.001). In the propensity score-matched cohort,the median OS was longer in group A than in group B(10.3 mo vs 6.0 mo,P < 0.001). Similarly,the median TTP was longer in group A than in group B(9.0 mo vs 3.4 mo,P < 0.001). Multivariate Cox analysis revealed that the EVBT combined with stent placement,TACE,and sorafenib strategy was an independent predictor of favorable OS(HR = 0.18,P < 0.001). CONCLUSION EVBT combined with stent placement,TACE,and sorafenib might be a safe and effective palliative treatment option for MPVTT.展开更多
Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery(VA) stenosis seems a safe,effective and useful technique for resolving symptoms and improving blood flow to the posterior circul...Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery(VA) stenosis seems a safe,effective and useful technique for resolving symptoms and improving blood flow to the posterior circulation,with a low complication rate and good long-term results.In patients with severe tortuosity of the vessel,stent placement is a real challenge.The new coronary balloon-expandable stents may be preferred.A large variability of restenosis rates has been reported.Drug-eluting stents may be the solution.After a comprehensive review of the literature,it can be concluded that percutaneous angioplasty and stenting of extracranial VA stenosis is technically feasible,but there is insufficient evidence from randomized trials to demonstrate that endovascular management is superior to best medical management.展开更多
Post-traumatic hepatic artery pseudoaneurysm is unc-ommon,appearing in approximately 1%of hepatic trauma cases.Most are extrahepatic(80%)and have a late onset.Although they are usually asymptomatic, they should always...Post-traumatic hepatic artery pseudoaneurysm is unc-ommon,appearing in approximately 1%of hepatic trauma cases.Most are extrahepatic(80%)and have a late onset.Although they are usually asymptomatic, they should always be treated becasue of the high risk of complications,especially breakage.Currently the treatment of choice is endovascular embolization with coils or the exclusion of the pseudoaneurysm using other intravascular devices.Recently there have been accounts of a treatment that combines embolization with coils and image-guided percutaneous human thrombin injection.We present a case of post-traumatichepatic artery pseudoaneurysm that was successfully treated using this combined technique.展开更多
We report a successful endovascular technique using a snare with a suture for retrieving a migrated broken peripherally inserted central catheter(PICC)in a chemotherapy patient.A 62-year-old male received monthly chem...We report a successful endovascular technique using a snare with a suture for retrieving a migrated broken peripherally inserted central catheter(PICC)in a chemotherapy patient.A 62-year-old male received monthly chemotherapy through a central venous port implanted into his right subclavian area.The patient completed chemotherapy without complications 1 mo ago;however,he experienced pain in the right subclavian area during his last chemotherapy session.Computed tomography on that day showed migration of a broken PICC in his left pulmonary artery,for which the patient was admitted to our hospital.We attempted to retrieve the ectopic PICC through the right jugular vein using a gooseneck snare,but were unsuccessful because the catheter was lodged in the pulmonary artery wall.Therefore,a second attempt was made through the right femoral vein using a snare with triple loops,but we could not grasp the migrated PICC.Finally,a string was tied to thetop of the snare,allowing us to curve the snare toward the pulmonary artery by pulling the string.Finally,the catheter body was grasped and retrieved.The endovascular suture technique is occasionally extremely useful and should be considered by interventional cardiologists for retrieving migrated catheters.展开更多
BACKGROUND:Fatal aortic rupture caused by esophageal foreign body(EFB),is associated with a high mortality,but can be prevented by thoracic endovascular aorta repair(TEVAR)that performed increasingly as technology imp...BACKGROUND:Fatal aortic rupture caused by esophageal foreign body(EFB),is associated with a high mortality,but can be prevented by thoracic endovascular aorta repair(TEVAR)that performed increasingly as technology improves.This study aims to investigate the cause,management and prognosis of suspected penetrating aortoesophageal foreign body injury.METHODS:Twelve cases who met the criteria were enrolled in this study.The demographic and clinical data were reviewed for evaluating the characteristics of EFB.RESULTS:Among 12 cases enrolled,7 were males and 5 were females,with an age 27–86 years.The distance of EFB from aorta(DFA)of 7 cases were less than or equal to 0 mm,5 cases were 0–2 mm.Eleven cases were managed with TEVAR,only one case was with open surgery standby but finally treated by flexible endoscopy(FE)successfully,without TEVAR.In group with TEVAR,EFB of 7 cases were successfully removed by rigid endoscopy(RE),and one of them was failed at the first RE treatment.EFB of 2 cases were successfully removed by open surgery with TEVAR,and other 9 cases were managed by endoscopies with TEVAR.The mean length of stay of hospitalization(LOS)and length of ICU stay of patients treated by open surgery with TEVAR(18.50±2.12 days and 5.50±0.71 days)was significantly longer than those of patients treated by endoscopy with TEVAR(7.00±2.74 days and 1.33±1.12 days,P<0.001 and P=0.001,respectively).Five cases had severe complications.CONCLUSION:Rational application of TEVAR can be a life-saving management for aortoesophageal foreign body injury,and jointed with endoscopy is safe and effective with a shorter length of ICU or total hospital stay.展开更多
Splenic arteriovenous fistulas(SAVFs) with splenic vein aneurysms are extremely rare entities. There have been no prior reports of SAVFs developing after laparoscopic pancreatectomy. Here, we report the first case. A ...Splenic arteriovenous fistulas(SAVFs) with splenic vein aneurysms are extremely rare entities. There have been no prior reports of SAVFs developing after laparoscopic pancreatectomy. Here, we report the first case. A 40-year-old man underwent a laparoscopic, spleen-preserving, distal pancreatectomy for an endocrine neoplasm of the pancreatic tail. Three months after surgery, a computed tomography(CT) scan demonstrated an SAVF with a dilated splenic vein. The SAVF, together with the splenic vein aneurysm, was successfully treated using percutaneous transarterial coil embolization of the splenic artery, including the SAVF and drainage vein. After the endovascular treatment, the patient's recovery was uneventful. He was discharged on postoperative day 6 and continues to be well 3 mo after discharge. An abdominal CT scan performed at his 3-mo follow-up demonstrated complete thrombosis of the splenic vein aneurysm, which had decreased to a 40 mm diameter. This is the first reported case of SAVF following a laparoscopic pancreatectomy and demonstrates the usefulness of endovascular treatment for this type of complication.展开更多
We present a case with hepatic myelopathy(HM) due to a surgical splenorenal shunt that was successfully treated by endovascular interventional techniques.A 39-year-old man presented with progressive spastic paraparesi...We present a case with hepatic myelopathy(HM) due to a surgical splenorenal shunt that was successfully treated by endovascular interventional techniques.A 39-year-old man presented with progressive spastic paraparesis of his lower limbs 14 mo after a splenorenal shunt.A portal venogram identified a widened patent splenorenal shunt.We used an occlusion balloon catheter initially to occlude the shunt.Further monitoring of the patient revealed a decrease in his serum ammonia level and an improvement in leg strength.We then used an Amplatzer vascular plug(AVP) to enable closure of the shunt.During the follow up period of 7 mo,the patient experienced significant clinical improvement and normalization of blood ammonia,without any complications.Occlusion of a surgically created splenorenal shunt with AVP represents an alternative therapy to surgery or coil embolization that can help to relieve shunt-induced HM symptoms.展开更多
Acute pulmonary embolism(PE) is the third most common cause of death in hospitalized patients. The development of sophisticated diagnostic and therapeutic modalities for PE, including endovascular therapy, affords a c...Acute pulmonary embolism(PE) is the third most common cause of death in hospitalized patients. The development of sophisticated diagnostic and therapeutic modalities for PE, including endovascular therapy, affords a certain level of complexity to the treatment of patients with this important clinical entity. Furthermore, the lack of level I evidence for the safety and effectiveness of catheter directed therapy brings controversy to a promising treatment approach. In this review paper, we discuss the pathophysiology and clinical presentation of PE, review the medical and surgical treatment of the condition, and describe in detail the tools that are available for the endovascular therapy of PE, including mechanical thrombectomy, suction thrombectomy, and fibrinolytic therapy. We also review the literature available to date on these methods, and describe the function of the Pulmonary Embolism Response Team.展开更多
Visceral artery aneurysms(VAAs) include aneurysms of the splanchnic circulation and those of the renal artery.Their diagnosis is clinically important because of the associated high mortality and potential complication...Visceral artery aneurysms(VAAs) include aneurysms of the splanchnic circulation and those of the renal artery.Their diagnosis is clinically important because of the associated high mortality and potential complications.Splenic,superior mesenteric,gastroduodenal,hepatic and renal arteries are some of the common arteries affected by VAAs.Though surgical resection and anastomosis still remains the treatment of choice in some of the cases,especially cases involving the proximal arteries,increasingly endovascular treatment is being used for more distal vessels.We present a pictorial review of various intra-abdominal VAAs and their endovascular management.展开更多
Pancreatico-duodenal artery(PDA) pseudoaneurysms are rare vascular conditions with high mortality rates after rupture and they are frequently secondary to pan-creatitis, surgery, trauma or infection. Due to the high r...Pancreatico-duodenal artery(PDA) pseudoaneurysms are rare vascular conditions with high mortality rates after rupture and they are frequently secondary to pan-creatitis, surgery, trauma or infection. Due to the high risk of rupture and bleeding, it is mandatory to treat all pseudoaneurysms, regardless of their size or symp-tomatology. First option of treatment is open surgical repair, but it has high mortality rate, especially in he-modynamically unstable patients. In the recent years, percutaneous ultrasonography(US)- or computed to-mography-guided thrombin injection was proposed as an alternative method for treating visceral aneurysms and pseudoaneurysms, but few reports described this therapy in case of peri-pancreatic pseudoaneurysms. We present a rare case of pseudoaneurysm of the PDA in a patient with no previous history of pancreatitis nor major surgery but with an occlusive lesion of the celiac axis. To the best of our knowledge this is the first reported case of PDA pseudoaneurysm successfully treated in emergency by single transabdominal US-guided injection of thrombin after failed attempts of percutaneous catheterization of the feeding vessel of the pseudoaneurysm.展开更多
基金Supported by Zhangjiajie"Xiao He(Young Talent)"Project,No.2024XHRC03Jishou University School-Level Research Project.
文摘BACKGROUND Aortic adverse remodeling remains a critical complication following thoracic endovascular aortic repair(TEVAR)for Stanford type B aortic dissection(TBAD),significantly impacting long-term survival.Accurate risk prediction is essential for optimized clinical management.AIM To develop and validate a logistic regression-based risk prediction model for aortic adverse remodeling following TEVAR in patients with TBAD.METHODS This retrospective observational cohort study analyzed 140 TBAD patients undergoing TEVAR at a tertiary center(2019–2024).Based on European guidelines,patients were categorized into adverse remodeling(aortic growth rate>2.9 mm/year,n=45)and favorable remodeling groups(n=95).Comprehensive variables(clinical/imaging/surgical)were analyzed using multivariable logistic regression to develop a predictive model.Model performance was assessed via receiver operating characteristic-area under the curve(AUC)and Hosmer-Lemeshow tests.RESULTS Multivariable analysis identified several strong independent predictors of negative aortic remodeling.Larger false lumen diameter at the primary entry tear[odds ratio(OR):1.561,95%CI:1.197–2.035;P=0.001]and patency of the false lumen(OR:5.639,95%CI:4.372-8.181;P=0.004)were significant risk factors.False lumen involvement extending to the thoracoabdominal aorta was identified as the strongest predictor,significantly increasing the risk of adverse remodeling(OR:11.751,95%CI:9.841-15.612;P=0.001).Conversely,false lumen involvement confined to the thoracic aorta demonstrated a significant protective effect(OR:0.925,95%CI:0.614–0.831;P=0.015).The prediction model exhibited excellent discrimination(AUC=0.968)and calibration(Hosmer-Lemeshow P=0.824).CONCLUSION This validated risk prediction model identifies aortic adverse remodeling with high accuracy using routinely available clinical parameters.False lumen involvement thoracoabdominal aorta is the strongest predictor(11.751-fold increased risk).The tool enables preoperative risk stratification to guide tailored TEVAR strategies and improve long-term outcomes.
基金the National Natural Science Foundation of China(No.52375293)the Research Fund of State Key Laboratory of Mechanics and Control for Aerospace Structures(Nanjing University of Aeronautics and astronautics,Nos.1005-IZD2300225 and IZD2400217)+2 种基金the Nanjing Life and Health Technology Special Project(No.202305031)the Clinical Competence Enhancement Project in Healthcare(No.JSPH-MB-2022-4)the Medical Engineering Translational Fund of Jiangsu Province Hospital(No.NM202402).
文摘Minimally invasive interventional surgery techniques using guidewire-based catheters are widely adopted to treat vascular diseases.However,commonly used interventional catheters lack active guidance.The use of guidewires is associated with risks,including increased exposure to X-rays and potential vascular damage during withdrawal from complex vessels.Herein,we developed sub-millimeter microtubular ionic actuators(0.6-0.8 mm outer diameter)integrated into steerable interventional catheters.These actuators can generate large deformations(>10 mm)under 7 V direct current due to enhanced ion migration,enabling precise navigation without the need for guidewires.The designed catheters achieved active bending and accurate positioning in complex arterial vascular branches within a human model.They were also able to navigate within different arterial locations(e.g.,the innominate,subclavian,and carotid arteries)in pigs without the use of guidewires,and even access the ventricle and deliver contrast medium,indicating their great potential for future endovascular therapy.
文摘BACKGROUND Delayed post-pancreatectomy hemorrhage(PPH)is life-threatening,and endovascular interventions show promise.This retrospective study aimed to evaluate endovascular treatment outcomes for delayed PPH and identify mortality risk factors.AIM To conduct a single-center retrospective study of 88 patients with delayed PPH to systematically evaluate the clinical efficacy of endovascular treatment,identify independent risk factors for six-month mortality,and propose and validate a predictive model for individualized management of high-risk patients.METHODS This retrospective analysis included 88 patients with delayed PPH treated by endovascular intervention.Patients were stratified into survival(n=64)and mortality(n=24)groups.Clinical and procedural variables were assessed using univariate and multivariate logistic regression.Significant predictors were incorporated into a prognostic nomogram.Model performance was assessed through discrimination(area under the receiver operating characteristic curve),calibration,and decision curve analysis.RESULTS Technical and clinical success rates were 92.0%and 60.2%,respectively.The overall six-month mortality rate was 27.3%(24/88).Independent predictors of mortality included advanced age,prolonged operative time,shorter hospital stay,intra-abdominal infection,coagulation dysfunction,common hepatic artery bleeding,and failure to achieve clinical success.The nomogram demonstrated excellent discrimination(area under the receiver operating characteristic curve=0.943),with good calibration and favorable net benefit on decision curve analysis.CONCLUSION We proposed and validated a predictive nomogram for six-month mortality following endovascular treatment for delayed PPH.The model facilitates individualized risk stratification and may guide clinical decision-making.Early identification of high-risk patients-particularly older individuals or those with infection or coagulopathy-and prompt,personalized intervention may improve outcomes in this high-risk population.
文摘BACKGROUND Intracranial blister-like microaneurysms are an extremely rare disease.Rupture of intracranial aneurysms can lead to subarachnoid hemorrhage(SAH).Patients with SAH may experience severe neurological symptoms,including severe headache,nausea,vomiting,transient or persistent loss of consciousness,limb weakness,and blurred vision.Ruptured aneurysms should be surgically treated as soon as possible.Intravascular electrocoagulation is becoming a promising treatment method for intracranial blister-like microaneurysms.The short-term follow-up results demonstrated that this method is safe and effective.This article presents a case of endovascular electrocoagulation for the treatment of a blisterlike microaneurysm.CASE SUMMARY This article reports the case of 71-year-old female patient with an intracranial aneurysm.The patient experienced a sudden headache with vomiting for 3 hours.Brain computed tomography(CT)scan showed a subarachnoid hemorrhage.She was diagnosed with rupture of an aneurysm and subarachnoid hemorrhage.The aneurysm was located in the choroidal segment of the right internal carotid artery.The size of the aneurysm was 2.00 mm×1.80 mm×1.97 mm,and the neck of the aneurysm was less than 0.5 mm wide.We successfully treated this aneurysm with endovascular electrocoagulation,and the patient was safely returned to the ward and discharged after subsequent supportive treatment.CT angiography reexamination 3 months after surgery revealed no contrast agent extravasation in the original lesion,with a good prognosis.CONCLUSION Endovascular electrocoagulation is an effective and safe method for the treatment of intracranial blister-like microaneurysms.
基金supported by the Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Education(RS-2024-00449812,2022R1I1A3064173)the Korea government(MSIT)(No.RS-2024-00335915).
文摘Nature-inspired designs have increasingly influenced biomedical engineering by providing superior biomechanical performance and structural stability.In this study,the diabolical ironclad beetle elytra structure was applied to stent strut designs and thoroughly evaluated through various computational simulations to assess their potential to enhance the mechanical performance of WE43 magnesium alloy stents.Connected elliptical structures with a vertical-to-horizontal length ratio of 1:1.8 were incorporated in varying numbers and then compared to conventional laser-cut stents using 3-point bending,crush,crimping,and expansion tests,internal carotid artery insertion simulations,and computational fluid dynamics analyses.The results demonstrated that the biomimetic stents exhibited significantly improved stress distribution and reduced applied stress while maintaining hemodynamic stability.Computational fluid dynamics simulations further confirmed that the biomimetic could reduce wall shear stress and improve blood flow,thereby potentially minimizing the risk of restenosis and thrombosis.These findings suggest that diabolical ironclad beetle-inspired stent structures may offer enhanced biomechanical performance and clinical safety in magnesium-based endovascular interventions.
文摘BACKGROUND Sex disparities in clinical outcomes following thoracic endovascular aortic repair(TEVAR)for acute complicated type B aortic dissection(TBAD)are not well understood.AIM To evaluates the impact of sex on primary and secondary outcomes by comparing male and female cohorts undergoing TEVAR.METHODS A systematic search of PubMed,EMBASE,Cochrane Library,and ScienceDirect identified five studies involving 2572 patients(1153 males and 1419 females).The primary outcome was hospital mortality.Secondary outcomes included reintervention rates,acute kidney injury(AKI),ischemic stroke,limb ischemia,and spinal cord ischemia.Odds ratios(OR)with 95%confidence intervals(CI)were calculated using a random-effects model.Heterogeneity was assessed using the I²statistic.RESULTS The primary outcome showed no significant difference between males and females for hospital mortality(OR:1.13,95%CI:0.81-1.59,P=0.47,I2=0).Among secondary outcomes,males had a significantly higher risk of AKI(OR:1.55,95%CI:1.21-2.00,P=0.0006,I²=0).No differences were observed for reintervention rates,ischemic stroke,limb ischemia,or spinal cord ischemia.CONCLUSION Male patients undergoing TEVAR for complicated TBAD are at increased risk of AKI but show comparable outcomes to females for mortality,ischemic events,reintervention,and other complications.Future research should explore mechanisms and strategies to optimize outcomes.
文摘BACKGROUND Descending thoracic aortic aneurysms are dangerous and have to be treated quickly.The primary treatment methods are thoracic endovascular aortic repair(TEVAR)and open surgical repair(OSR).The comparative effectiveness and safety of TEVAR and OSR were evaluated in this meta-analysis,focusing on perioperative and long-term outcomes.AIM To compare and contrast the efficacy and safety of TEVAR vs OSR in the treatment of descending thoracic aortic aneurysms.This study aims to assess both perioperative and long-term outcomes through a systematic review and metaanalysis.METHODS A comprehensive search of PubMed,EMBASE,and Cochrane was conducted from inception to January 2025.Baseline characteristics and outcomes were evaluated.Odds ratios(OR)for dichotomous data and mean differences for continuous data with 95%confidence intervals(CI)were analyzed using random-effects models.RESULTS A meta-analysis of 21 studies involving 29465 patients(8261 TEVAR;21204 OR)showed TEVAR associated with lower operative mortality(OR=0.60,95%CI:0.42-0.85,P=0.004),shorter intensive care unit(-2.94 days,95%CI:-4.76 to-1.12,P=0.002)and hospital stays(-7.35 days,95%CI:-10.54 to-4.17,P<0.00001),and reduced rates of paraplegia(OR=0.44,95%CI:0.27-0.73,P=0.002),spinal ischemia(OR=0.30,95%CI:0.16-0.56,P=0.0002),renal failure(OR=0.29,95%CI:0.14-0.61,P=0.001),and wound infections(OR=0.28,95%CI:0.13-0.61,P=0.001).However,TEVAR had higher rates of vascular complications.No significant differences were noted in 1-year and 5-year mortality rates,the rate of non-elective surgery,neurological complications,or stroke rates.CONCLUSION Compared to EVAR,TEVAR revealed lower operative mortality and better perioperative outcomes across all indicators,including hospital and intensive care unit stays,as well as fewer complications,except for those related to vascular problems.Mortality results were also similar in the long run;consequently,more research is required concerning the long-term durability.
文摘BACKGROUND Peripheral endovascular intervention(PEVI)is performed using radiation.Radiation has deleterious health consequences for patients and operators.AIM To investigate the gender radiation disparities and procedural outcomes in PEVI.METHODS A prospective observational study was performed in 186 consecutive patients(65±12 years)at an academic medical center from January 2019 to April 2020(mean follow-up of 3.9±3.6 months)comparing the gender radiation disparity and outcomes of PEVI(n=147 underwent intervention,79.0%).Groups were divided into women(n=99,53.2%)and men(n=87,48.4%).Primary endpoints included air kerma,dose area product(DAP),fluoroscopy time,and contrast use.Secondary endpoints included all-cause mortality,acute myocardial infarction,acute kidney injury,stroke,repeat revascularization,major adverse limb event,and the composite of complications.RESULTS Men showed increased DAP compared with women(15221.2±25858.5µGy×m^(2) vs 9251.7±9555.3µGy×m^(2),P=0.047),but no significant difference in air kerma or any other primary endpoints.In the secondary endpoints,no significant diffe-rence was found between gender.CONCLUSION Men had increased DAP indicating more radiation absorption in the exposed area.Gender outcomes showed no difference in complications.Thus,PEVI can be safely performed in men or women.
文摘The virtual reality based motion simulation of the guide wire and the catheter inside specific vascular structures can benefit a lot for the endovascular intervention. A fast and well-performed collision cancellation algorithm is proposed based on the geometric analysis and the angular propagation （AP）, and a 3-D real-time interactive system is developed for the motion simulation of the guide wire and the catheter inside the specific patient vascular. The guide wire or the catheter is modeled as the ＂multi-body＂ representation and properties are defined by its intrinsic characteristics. The motion of the guide wire or the catheter inside the vascular is guided by the collision detection and the collision cancellation algorithm. Finally, a relaxation procedure is used to achieve more realistic status. Experimental results show that the behavior of the guide wire or the catheter depends on the defined parameters. The real-time simulation can be achieved. The result shows that the simulation system is effective and promising.
文摘Carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. Several classification schemes have described carotid cavernous sinus fistulas according to etiology, hemodynamic features, or the angiographic arterial architecture. Increased pressure within the cavernous sinus appears to be the main factor in pathophysiology. The clinical features are related to size, exact location, and duration of the fistula, adequacy and route of venous drainage and the presence of arterial/venous collaterals. Noninvasive imaging (computed tomography, magnetic resonance, computed tomography angiography, magnetic resonance angiography, Doppler) is often used in the initial workup of a possible carotid cavernous sinus fistulas. Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of treatment for these lesions. The endovascular approach has evolved as the mainstay therapy for definitive treatment in situations including clinical emergencies. Conservative treatment, surgery and radiosurgery constitute other management options for these lesions.
基金Supported by the Project of Advanced and Appropriate Technique Generalization of Shanghai Health and Family Planning Committee,No.2013SY060the Scientific Program of Shanghai Municipal Heath Bureau,No.20124188
文摘AIM To evaluate the safety and efficacy of combined endovascular brachytherapy(EVBT),transarterial chemoembolization(TACE),and sorafenib to treat hepatocellular carcinoma(HCC) patients with main portal vein tumor thrombus(MPVTT).METHODS This single-center retrospective study involved 68 patients with unresectable HCC or those who were unfit for liver transplantation and percutaneous frequency ablation according to the BCLC classification. All patients had Child-Pugh classification grade A or B,Eastern Cooperative Oncology Group(ECOG)performance status of 0-2,and MPVTT. The patients received either EVBT with stent placement,TACE,and sorafenib(group A,n = 37),or TACE with sorafenib(group B,n = 31). The time to progression(TTP) and overall survival(OS) were evaluated by propensity score analysis.RESULTS In the entire cohort,the 6-,12-,and 24-mo survival rates were 88.9%,54.3%,and 14.1% in group A,and 45.8%,0%,and 0% in group B,respectively(P < 0.001). The median TTP and OS were significantly longer in group A than group B(TTP: 9.0 mo vs 3.4 mo,P < 0.001; OS: 12.3 mo vs 5.2 mo,P < 0.001). In the propensity score-matched cohort,the median OS was longer in group A than in group B(10.3 mo vs 6.0 mo,P < 0.001). Similarly,the median TTP was longer in group A than in group B(9.0 mo vs 3.4 mo,P < 0.001). Multivariate Cox analysis revealed that the EVBT combined with stent placement,TACE,and sorafenib strategy was an independent predictor of favorable OS(HR = 0.18,P < 0.001). CONCLUSION EVBT combined with stent placement,TACE,and sorafenib might be a safe and effective palliative treatment option for MPVTT.
文摘Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery(VA) stenosis seems a safe,effective and useful technique for resolving symptoms and improving blood flow to the posterior circulation,with a low complication rate and good long-term results.In patients with severe tortuosity of the vessel,stent placement is a real challenge.The new coronary balloon-expandable stents may be preferred.A large variability of restenosis rates has been reported.Drug-eluting stents may be the solution.After a comprehensive review of the literature,it can be concluded that percutaneous angioplasty and stenting of extracranial VA stenosis is technically feasible,but there is insufficient evidence from randomized trials to demonstrate that endovascular management is superior to best medical management.
基金Supported by Departments of Radiology and Surgery at University general hospital Virgen de la Arrixaca
文摘Post-traumatic hepatic artery pseudoaneurysm is unc-ommon,appearing in approximately 1%of hepatic trauma cases.Most are extrahepatic(80%)and have a late onset.Although they are usually asymptomatic, they should always be treated becasue of the high risk of complications,especially breakage.Currently the treatment of choice is endovascular embolization with coils or the exclusion of the pseudoaneurysm using other intravascular devices.Recently there have been accounts of a treatment that combines embolization with coils and image-guided percutaneous human thrombin injection.We present a case of post-traumatichepatic artery pseudoaneurysm that was successfully treated using this combined technique.
文摘We report a successful endovascular technique using a snare with a suture for retrieving a migrated broken peripherally inserted central catheter(PICC)in a chemotherapy patient.A 62-year-old male received monthly chemotherapy through a central venous port implanted into his right subclavian area.The patient completed chemotherapy without complications 1 mo ago;however,he experienced pain in the right subclavian area during his last chemotherapy session.Computed tomography on that day showed migration of a broken PICC in his left pulmonary artery,for which the patient was admitted to our hospital.We attempted to retrieve the ectopic PICC through the right jugular vein using a gooseneck snare,but were unsuccessful because the catheter was lodged in the pulmonary artery wall.Therefore,a second attempt was made through the right femoral vein using a snare with triple loops,but we could not grasp the migrated PICC.Finally,a string was tied to thetop of the snare,allowing us to curve the snare toward the pulmonary artery by pulling the string.Finally,the catheter body was grasped and retrieved.The endovascular suture technique is occasionally extremely useful and should be considered by interventional cardiologists for retrieving migrated catheters.
基金the Foundation of Key Discipline Construction of Zhejiang Province for Traditional Chinese Medicine (2017-XK-A36)the Key Research and Development Program of Zhejiang Province (2019C03076).
文摘BACKGROUND:Fatal aortic rupture caused by esophageal foreign body(EFB),is associated with a high mortality,but can be prevented by thoracic endovascular aorta repair(TEVAR)that performed increasingly as technology improves.This study aims to investigate the cause,management and prognosis of suspected penetrating aortoesophageal foreign body injury.METHODS:Twelve cases who met the criteria were enrolled in this study.The demographic and clinical data were reviewed for evaluating the characteristics of EFB.RESULTS:Among 12 cases enrolled,7 were males and 5 were females,with an age 27–86 years.The distance of EFB from aorta(DFA)of 7 cases were less than or equal to 0 mm,5 cases were 0–2 mm.Eleven cases were managed with TEVAR,only one case was with open surgery standby but finally treated by flexible endoscopy(FE)successfully,without TEVAR.In group with TEVAR,EFB of 7 cases were successfully removed by rigid endoscopy(RE),and one of them was failed at the first RE treatment.EFB of 2 cases were successfully removed by open surgery with TEVAR,and other 9 cases were managed by endoscopies with TEVAR.The mean length of stay of hospitalization(LOS)and length of ICU stay of patients treated by open surgery with TEVAR(18.50±2.12 days and 5.50±0.71 days)was significantly longer than those of patients treated by endoscopy with TEVAR(7.00±2.74 days and 1.33±1.12 days,P<0.001 and P=0.001,respectively).Five cases had severe complications.CONCLUSION:Rational application of TEVAR can be a life-saving management for aortoesophageal foreign body injury,and jointed with endoscopy is safe and effective with a shorter length of ICU or total hospital stay.
文摘Splenic arteriovenous fistulas(SAVFs) with splenic vein aneurysms are extremely rare entities. There have been no prior reports of SAVFs developing after laparoscopic pancreatectomy. Here, we report the first case. A 40-year-old man underwent a laparoscopic, spleen-preserving, distal pancreatectomy for an endocrine neoplasm of the pancreatic tail. Three months after surgery, a computed tomography(CT) scan demonstrated an SAVF with a dilated splenic vein. The SAVF, together with the splenic vein aneurysm, was successfully treated using percutaneous transarterial coil embolization of the splenic artery, including the SAVF and drainage vein. After the endovascular treatment, the patient's recovery was uneventful. He was discharged on postoperative day 6 and continues to be well 3 mo after discharge. An abdominal CT scan performed at his 3-mo follow-up demonstrated complete thrombosis of the splenic vein aneurysm, which had decreased to a 40 mm diameter. This is the first reported case of SAVF following a laparoscopic pancreatectomy and demonstrates the usefulness of endovascular treatment for this type of complication.
文摘We present a case with hepatic myelopathy(HM) due to a surgical splenorenal shunt that was successfully treated by endovascular interventional techniques.A 39-year-old man presented with progressive spastic paraparesis of his lower limbs 14 mo after a splenorenal shunt.A portal venogram identified a widened patent splenorenal shunt.We used an occlusion balloon catheter initially to occlude the shunt.Further monitoring of the patient revealed a decrease in his serum ammonia level and an improvement in leg strength.We then used an Amplatzer vascular plug(AVP) to enable closure of the shunt.During the follow up period of 7 mo,the patient experienced significant clinical improvement and normalization of blood ammonia,without any complications.Occlusion of a surgically created splenorenal shunt with AVP represents an alternative therapy to surgery or coil embolization that can help to relieve shunt-induced HM symptoms.
文摘Acute pulmonary embolism(PE) is the third most common cause of death in hospitalized patients. The development of sophisticated diagnostic and therapeutic modalities for PE, including endovascular therapy, affords a certain level of complexity to the treatment of patients with this important clinical entity. Furthermore, the lack of level I evidence for the safety and effectiveness of catheter directed therapy brings controversy to a promising treatment approach. In this review paper, we discuss the pathophysiology and clinical presentation of PE, review the medical and surgical treatment of the condition, and describe in detail the tools that are available for the endovascular therapy of PE, including mechanical thrombectomy, suction thrombectomy, and fibrinolytic therapy. We also review the literature available to date on these methods, and describe the function of the Pulmonary Embolism Response Team.
文摘Visceral artery aneurysms(VAAs) include aneurysms of the splanchnic circulation and those of the renal artery.Their diagnosis is clinically important because of the associated high mortality and potential complications.Splenic,superior mesenteric,gastroduodenal,hepatic and renal arteries are some of the common arteries affected by VAAs.Though surgical resection and anastomosis still remains the treatment of choice in some of the cases,especially cases involving the proximal arteries,increasingly endovascular treatment is being used for more distal vessels.We present a pictorial review of various intra-abdominal VAAs and their endovascular management.
文摘Pancreatico-duodenal artery(PDA) pseudoaneurysms are rare vascular conditions with high mortality rates after rupture and they are frequently secondary to pan-creatitis, surgery, trauma or infection. Due to the high risk of rupture and bleeding, it is mandatory to treat all pseudoaneurysms, regardless of their size or symp-tomatology. First option of treatment is open surgical repair, but it has high mortality rate, especially in he-modynamically unstable patients. In the recent years, percutaneous ultrasonography(US)- or computed to-mography-guided thrombin injection was proposed as an alternative method for treating visceral aneurysms and pseudoaneurysms, but few reports described this therapy in case of peri-pancreatic pseudoaneurysms. We present a rare case of pseudoaneurysm of the PDA in a patient with no previous history of pancreatitis nor major surgery but with an occlusive lesion of the celiac axis. To the best of our knowledge this is the first reported case of PDA pseudoaneurysm successfully treated in emergency by single transabdominal US-guided injection of thrombin after failed attempts of percutaneous catheterization of the feeding vessel of the pseudoaneurysm.
