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Successful transcatheter arterial embolization for pseudoaneurysm of the deep femoral artery in a patient with presumptive ACTA2-related vasculopathy.

ABSTRACT: ACTA2-related vasculopathy is an autosomal dominant genetic disorder characterized by aortic aneurysms and dissection, and limb artery lesions are rare. We report a case of transcatheter arterial embolization for a pseudoaneurysm of a deep femoral artery in a patient with presumptive ACTA2-related vasculopathy. A 58-year-old woman was presumed to have an ACTA2 mutation based on her history of aortic diseases and family history of ACTA2 mutations. During follow-up, contrast-enhanced computed tomography for aortic diseases revealed occlusion and vessel wall abnormalities of the bilateral deep femoral arteries. Two weeks later, she complained of acute right inguinal pain without any triggering factors, and contrast-enhanced computed tomography revealed a pseudoaneurysm of the right deep femoral artery. Vascular fragility due to ACTA2 mutation was believed to be the cause of the pseudoaneurysm. Transcatheter arterial embolization was successfully performed and no rebleeding occurred during 1.5 years after the transcatheter arterial embolization.

SUBMITTER: Kamio S

PROVIDER: S-EPMC8495039 | biostudies-literature | 2021 Dec

REPOSITORIES: biostudies-literature

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Successful transcatheter arterial embolization for pseudoaneurysm of the deep femoral artery in a patient with presumptive ACTA2-related vasculopathy.

Kamio Satoru S Kubo Takatoshi T Koshino Saori S Abe Osamu O

Radiology case reports 20211001 12

ACTA2-related vasculopathy is an autosomal dominant genetic disorder characterized by aortic aneurysms and dissection, and limb artery lesions are rare. We report a case of transcatheter arterial embolization for a pseudoaneurysm of a deep femoral artery in a patient with presumptive ACTA2-related vasculopathy. A 58-year-old woman was presumed to have an <i>ACTA2</i> mutation based on her history of aortic diseases and family history of <i>ACTA2</i> mutations. During follow-up, contrast-enhanced ...[more]

PMID: 34630793

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Project description:BackgroundAfter orthotopic liver transplantation (OLT), complications such as hepatic artery stenosis, thrombosis, and bleeding are possible. Hepatic artery pseudoaneurysms (HAP) are prone to rupture, rupture hemorrhage, and increased mortality risk. Endovascular treatment of HAP may result in recurrence, even after successful embolization with thrombin. Formation of a HAP in the common hepatic artery (CHA) is challenging because the CHA is the only artery in the liver graft after OLT. Therefore, CHA embolization in HAP is not an initial option. We report a case of HAP at the CHA after OLT that was treated with endovascular therapy, resulting in the occlusion of the CHA with coil embolization, achieving a radical cure.Case presentationA 59-year-old man with decompensated hepatitis C virus cirrhosis underwent deceased donor whole-liver transplantation after graft failure of a living donor liver transplantation. After the second transplantation, the patient developed infectious narrow-necked HAP at the CHA associated with postoperative pancreatic fistula. Repeated transcatheter arterial embolization with thrombin and n-butyl-2-cyanoacrylate was unsuccessful, as confirmed by postprocedure angiography, which revealed recanalization and regrowth of the HAP. Eight months after the first transcatheter arterial embolization, the patient presented with a chief complaint of abdominal pain due to an enlarged HAP. Angiography of the superior mesenteric artery (SMA) revealed a collateral bypass around the bile duct from the SMA to the liver graft. Coil embolization of the HAP in the CHA completely occluded the HAP without complications. More than 2 years after coil embolization, the liver graft function test results remained within normal limits without HAP recurrence.ConclusionsHAP at the CHA after liver transplantation can be fatal if ruptured. Because the liver is a highly angiogenic organ, even if initial treatment is not successful, radical treatment to occlude the CHA with HAP is possible if sufficient collateral vessels are developed.

Project description:BackgroundVisceral artery pseudoaneurysm (VAPA) may result from trauma, operation, infection, inflammation, vasculitis, or malignancy. Factors associated with clinical success transarterial embolization (TAE) of VAPA have never been reported. The aim of this retrospective monocentric study was to describe clinical presentation and outcomes for patients treated for VAPA with TAE, and to identify factors associated with clinical success.MethodsWe retrospectively reviewed data from all patients referred to the University Hospital of Saint-Etienne treated with TAE for VAPA between October 2012 and January 2023. Inclusion criteria included: all patients treated by TAE for VAPA arising from branches of the coeliac trunk, superior mesenteric artery, and renal artery. We considered pre- and per-procedure clinical data, biological data, outcomes, and complications. Post-operative data included early mortality (≤30 days), repeat embolization, and complications. Predictive factors associated with clinical success were evaluated.ResultsOur sample included 89 patients (68 males). The median age was 65 [49-74] [median (Q1-Q3)] years, and the median hemoglobin level was 9 (7.6-11) g/dL. On pre-operative computed tomography (CT), active bleeding was detected in 31 (34.8%) patients. Coils were used in 58 (65.2%) procedures. Clinical success was achieved in 77 (86.5%) patients. There were 11 (12.4%) minor complications. Five (5.6%) patients died within the first 30 days. In univariate analysis, hemoglobin levels were associated with clinical success (P=0.027) and number of red blood cell (RBC) transfusions (P=0.007) and gastrointestinal bleedings (P=0.005) were associated with clinical failure. No factors were statistically significant in multivariate analysis.ConclusionsLow hemoglobin levels, high numbers of RBC transfusions, and gastrointestinal bleedings were associated with clinical failure after TAE for VAPA. Multicentre studies are needed to investigate further.

Dataset Information

Successful transcatheter arterial embolization for pseudoaneurysm of the deep femoral artery in a patient with presumptive ACTA2-related vasculopathy.

Publications

Successful transcatheter arterial embolization for pseudoaneurysm of the deep femoral artery in a patient with presumptive ACTA2-related vasculopathy.

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