CASE PRESENTATION

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.

PROCEDURE DESCRIPTION

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).

Figure 1.

Figure 2.

Figure 3.

Figure 4.

After several failures, a 2.4-F 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

Final angiography (Figure 4) showed that complete embolization of the two aneurysms was successfully achieved, and the native circulation was preserved.

Results from case studies are not necessarily predictive of results in other cases. Results in other cases may vary. 

Marco Santoro, MD, PhD
Interventional Radiologist
Spirito Santo Hospital
Pescara, Italy
Disclosures: None.