Arterial Interventions and Peripheral Arterial Disease (PAD)

Session: Educational Exhibit Presentations - Station 1: Arterial Interventions and Peripheral Arterial Disease (PAD)

Alternative Access Sites: Transvisceral Arterial Interventions

Monday, March 6, 2023

5:10 PM – 5:15 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

Harika Dabbara

Medical Student
Boston University

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

JL

Jingfei Li, MD

Resident
BIDMC
MA

Muneeb Ahmed, MD FSIR

Chief, Division of Interventional Radiology
Beth Israel Deaconess Medical Center/Harvard
Vijay Ramalingam, MD

Vascular Interventional Radiologist
Beth Israel Deaconess Medical Center
JW

Jeffrey Weinstein, MD FSIR

Program Director, Interventional Radiology Residency Programs
Beth Israel Deaconess Medical Center/Harvard Medical School
Julie C. Bulman, MD

Interventional Radiologist
Beth Israel Deaconess Medical Center, Harvard Medical School

Disclosure(s):

Harika Dabbara: No financial relationships to disclose

Muneeb Ahmed, MD FSIR: Agile Devices, Inc.: Advisory Committee or Review Panel Member (Ongoing), Consultant (Ongoing), Ownership Interest (Ongoing); Replimune, Inc.: Consultant (Ongoing); RevOps Health, Inc.: Advisory Committee or Review Panel Member (Ongoing), Consultant (Ongoing), Ownership Interest (Ongoing)

Vijay Ramalingam, MD: No financial relationships to disclose

Jeffrey Weinstein, MD FSIR: BAIM Institute: Advisory Committee or Review Panel Member (Ongoing); Instylla: Advisory Committee or Review Panel Member (Ongoing)

Julie C. Bulman, MD: Argon Medical Devices: Consultant (Ongoing)

Learning Objectives:

To review indications and rationale for performing transvisceral arterial intervention. We illustrate three cases of transsplenic or transhepatic arterial access. Each case highlights the anatomy and benefits for these access techniques.

Background:

Femoral and radial access are conventional access sites for performing splenic or hepatic arterial interventions. However, traditional access may not work when faced with certain barriers. In these cases, transsplenic or transhepatic arterial access may be attempted to perform the intervention.

Clinical Findings/Procedure Details:

A. A patient with a deceased donor liver transplant presented with evidence of splenic artery steal syndrome. Traditional endovascular splenic embolization was not possible due to previous splenic artery ligation. Transsplenic arterial access was gained with a 21-G needle and microsystem. Splenic embolization of the mid and lower poles was performed using particles and coils. Transsplenic arterial access was closed using gelfoam pledgets.

B. A patient with history of deceased donor liver transplant presented with a hepatic artery pseudoaneurym after stenting of a hepatic artery stenosis. Covered stent placement to treat the pseudoaneurysm via transarterial access was not possible due to vessel tortuosity and prior stenting. Transhepatic access into a right hepatic artery branch was performed and the transhepatic wire was snared from the left radial artery access for through-and-through access. A covered stent was successfully deployed transhepatically to cover the pseudoaneurysm. The transhepatic access was closed using coils and thick gelfoam.

C. A patient with a 3cm splenic artery aneurysm presented for embolization. Tortuosity of the splenic artery proximal to the aneurysm prevented anterograde stent deployment. Percutaneous access of the intraparenchymal splenic artery was obtained and a wire was advanced through the aneurysm to the proximal splenic artery. The wire was snared from brachial access to obtain through-and-through access. Stents were then deployed over the wire to span the aneurysm neck. Stent assisted coiling was performed for packing. A coil was deployed through the microcatheter to close the splenic arterial access site after removal of the wire. Final arteriogram demonstrated flow to the upper pole of the spleen and occlusion of the aneurysm.

Conclusion and/or Teaching Points:

Transsplenic and transhepatic arterial access are potential alternatives when barriers are present to traditional arterial access and are beneficial to be familiar with.