Direct sonographic-guided superior gluteal artery access for treatment of a previously treated expanding internal iliac artery aneurysm Michael M. Herskowitz,

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Presentation transcript:

Direct sonographic-guided superior gluteal artery access for treatment of a previously treated expanding internal iliac artery aneurysm Michael M. Herskowitz, MD, James Walsh, MD, David T. Jacobs, MD Journal of Vascular Surgery Volume 59, Issue 1, Pages 235-237 (January 2014) DOI: 10.1016/j.jvs.2013.03.001 Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 1 A, Axial computed tomography (CT) image through the pelvis demonstrates an aneurysmal dilatation of the left internal iliac artery (arrow). High-density material in the posterior aspect of the aneurysm is a previously placed coil. B, Digital subtraction angiogram of the aorta demonstrates proximal stump of previously embolized internal iliac artery (curved arrow). Coils from the prior embolization are seen (arrowhead). Expanding internal iliac artery aneurysm fills from the superior gluteal artery and collaterals (arrow). Journal of Vascular Surgery 2014 59, 235-237DOI: (10.1016/j.jvs.2013.03.001) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 2 A, Fluoroscopic spot image after direct cannulation and contrast injection of left superior gluteal artery demonstrates filling of the aneurysm sac and distal runoff vessels (arrow). Coils from prior embolization are seen (arrowheads). B, Digital subtraction angiogram after coil embolization demonstrates nonfilling of aneurysm sac (arrow). Coils from prior embolization are seen (arrowheads). Bowel gas artifact is indicated (black arrow). Journal of Vascular Surgery 2014 59, 235-237DOI: (10.1016/j.jvs.2013.03.001) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 3 A, Axial image from pelvic computed tomography (CT) angiogram several months after embolization demonstrates thrombosed, partially calcified left internal iliac artery aneurysm (white arrow). There is significant beam hardening artifact due to the presence of numerous metallic coils within the aneurysm sac. The left and right external iliac and right internal iliac arteries are normally opacified (dashed arrows). Also seen is a coil within the left gluteus maximus, near the superior gluteal artery access point (black arrowhead). B, Three-dimensional reconstruction of pelvic CT angiogram (oblique view) demonstrates residual stump of the left internal iliac artery (arrow), coil from the first embolization procedure (dashed arrow), and coil nest and thrombosed aneurysm (arrowheads). Journal of Vascular Surgery 2014 59, 235-237DOI: (10.1016/j.jvs.2013.03.001) Copyright © 2014 Society for Vascular Surgery Terms and Conditions