Visceral artery pseudoaneurysm: predictive factors for clinical success after transarterial embolization

Background: Visceral 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.

Methods: We 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.

Results: Our 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.

Conclusions: Low 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.