Farouk Tradi

Pulmonary artery pseudoaneurysms pose a therapeutic challenge due to their lack of a defined wall, making the choice of endovascular therapy crucial. The added complexity arises from their proximal location, often necessitating endovascular stenting for effective treatment. Our case highlights a successful therapeutic intervention involving stenting and glue embolization to address a sizable proximal pseudoaneurysm in the right pulmonary artery. This approach demonstrates the efficacy of combining these techniques in managing such challenging cases. The utilization of endovascular stenting, coupled with glue embolization, could be a therapeutic option in the context of giant pseudoaneurysms located proximally within the pulmonary artery.

Objective To prospectively compare the safety of transcatheter embolization of superior rectal arteries in healthy pigs with multiple agents such as coils, spheres and liquids. Materials and Methods Nine adult domestic pigs (three males, mean weight: 60 kg [50–70]) were randomly assigned to the embolization group: copolymer of ethylene vinyl alcohol (EVOH)—Onyx® (group 1, n = 3), microspheres 500 µ (group 2, n = 3), 2-mm micro-coils (group 3, n = 3). After a selective angiogram has been acquired, the embolic agent was infused at the distal part of rectal arteries. An angio-CT was performed before and after each embolization. After one week, angiography was repeated prior to euthanasia. At necropsy, the anorectal juncture was removed for histopathologic examination. Results At necropsy, 100% of animals embolized with Onyx developed a significant necrosis zone of the distal part of the rectum. Histological examination revealed a mural infarction. For the micro-coil and microsphere groups, gross examination of the intestines did not reveal any evidence of ischaemia. The coils were found in the distal arterial vasculature of the meso-rectum, allowing a downstream revascularization by collaterals. The microspheres and onyx in the rectal wall, more distally. Conclusion Microspheres appear to induce fewer histologic complications than the liquid embolic agent and provide a more distal occlusion than micro-coils. These results suggest that, for superior rectal artery embolization, a super-selective embolization using spheres in human clinical conditions should be more effective and as safe as coil embolization. EVOH might be an unsafe embolization agent for haemorrhoids.