Embolization of Inferior Pancreaticoduodenal Artery Aneurysms Using the Direxion™ Torqueable Microcatheter
A 77-year-old woman was referred for treatment of two aneurysms (24 X 20 mm and 20 X 18 mm) arising from the inferior pancreaticoduodenal artery (Figure 1). The celiac artery showed chronic total occlusion. The case was discussed with the vascular surgery team before deciding to proceed with coil embolization of both aneurysms.
Femoral access was achieved and preshaped microcatheters were chosen to reach the target lesions. Many unsuccessful attempts were made to cannulate the aneurysms using a preshaped 45° tip microcatheter and a 90° tip microcatheter (Figure 2).
After several failures, a 2.4-F (0.8-mm) Direxion™ Torqueable Microcatheter with the Transend™-14 System and a pre-shaped swan neck tip was chosen. The Direxion™ Torqueable Microcatheter was then successfully advanced over a Transend™-14 Guidewire until it reached the two aneurysms (Figure 3). The microcatheter’s swan neck–shaped tip was crucial to the success of the procedure because it facilitated access through this challenging anatomy.
A coil packing technique was then performed using Interlock™-18 Fibered Detachable Coils to achieve complete embolization of both aneurysms.
FOLLOW-UP AND DISCUSSION
Marco Santoro, MD, PhD
Spirito Santo Hospital