Transcatheter arterial embolization for the management of iatrogenic and blunt traumatic intercostal artery injuries Andreas P. Chemelli, MD, Michael.

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Presentation transcript:

Transcatheter arterial embolization for the management of iatrogenic and blunt traumatic intercostal artery injuries Andreas P. Chemelli, MD, Michael Thauerer, MD, Franz Wiedermann, MD, Alexander Strasak, PhD, Josef Klocker, MD, Iris E. Chemelli- Steingruber, MD Journal of Vascular Surgery Volume 49, Issue 6, Pages 1505-1513 (June 2009) DOI: 10.1016/j.jvs.2009.02.001 Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 1 A 57-year-old patient (patient 3). a, Contrast enhanced computed tomography (CT) of the thorax reveals a fracture of the second to the tenth left ribs and a pseudoaneurysm within the chest wall, originating from the injured tenth intercostal artery (ICA). b, The same CT study shows a contrast extravasation into the pleural cavity in addition to the pseudoaneurysm seen above. Journal of Vascular Surgery 2009 49, 1505-1513DOI: (10.1016/j.jvs.2009.02.001) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 2 A 71-year-old patient (patient 20). a, Chest x-ray shows left-sided hemothorax after puncture of a pleural effusion. b, Selective angiography of the ninth intercostal artery (ICA) demonstrates a pseudoaneurysm of a small side branch of the ICA. c, Selective angiography shows successful closure of the bleeding source by means of microcoils and PVA particles. d, Chest x-ray after endovascular intervention and insertion of chest tubes shows disappearance of pleural effusion and hemothorax. Journal of Vascular Surgery 2009 49, 1505-1513DOI: (10.1016/j.jvs.2009.02.001) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 3 Kaplan-Meier estimates of cumulative survival in group A (blunt traumatic injuries) and group B (iatrogenic injuries). Journal of Vascular Surgery 2009 49, 1505-1513DOI: (10.1016/j.jvs.2009.02.001) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 4 A 58-year-old patient (patient 6). a, Selective angiography demonstrates a pseudoaneurysm, which arises from the ninth intercostal artery (ICA). b, Selective angiography shows that the pseudoaneurysm is also fed by the musculophrenic artery (via the internal mammary artery). c, Selective angiography reveals a third route of blood supply to the pseudoaneurysm via the inferior phrenic artery. Journal of Vascular Surgery 2009 49, 1505-1513DOI: (10.1016/j.jvs.2009.02.001) Copyright © 2009 Society for Vascular Surgery Terms and Conditions