Percutaneous Direct Puncture and Embolization of Thoraco-abdominal Arterial Pseudoaneurysms

Abstract To evaluate the technical success and clinical outcomes of percutaneous direct puncture and embolization of thoraco-abdominal arterial pseudoaneurysms in patients for whom an endovascular approach was unsuccessful or inaccessible. A retrospective analysis was conducted on patients who underwent direct percutaneous embolization for thoracic and abdominal arterial pseudoaneurysms following inaccessible or unsuccessful endovascular intervention at a quaternary care referral centre between January 2022 and May 2025. Nine patients who underwent direct percutaneous embolization for thoraco-abdominal pseudoaneurysms were identified. Patient demographics, procedural details, complications, and clinical outcomes were systematically evaluated. This study identified nine patients (seven males and two females) who underwent percutaneous embolization of thoraco-abdominal arterial pseudoaneurysms, with a mean age of 40.9 ± 10.45 years (range: 23–52 years). Eight patients (88.9%) underwent percutaneous embolization using a 22-G spinal or Chiba needle. Ultrasound guidance was employed in seven cases (77.8%), while two patients (22.2%) required fluoroscopic guidance. Technical and clinical success was achieved in all patients (100%). Re-intervention was needed in one patient following percutaneous embolization with thrombin; the patient subsequently underwent successful re-embolization using N-butyl cyanoacrylate (NBCA) glue. One patient with a pulmonary artery pseudoaneurysm experienced persistent streaky hemoptysis post-embolization due to coexistent lung pathology, but no pseudoaneurysm recurrence or rebleeding was observed in any case during the follow-up. No major complications were reported. Percutaneous direct puncture and embolization is a safe and useful technique for managing thoraco-abdominal arterial pseudoaneurysms when an endovascular approach is unsuccessful or unfeasible.