Direct percutaneous embolization of an iatrogenic lumbar artery pseudoaneurysm following unsuccessful coil embolization

Abstract

A 56-year-old man with acute myeloleukemia was hospitalized for lumbar pain. Treatment with antibiotics failed to improve the symptoms. For the diagnosis of infiltration by leukemia we performed CT-guided percutaneous needle biopsy of the L2-L3 disc and the L3 vertebral body using a left posterolateral approach. His symptoms were improved by treatment with antibiotics and he was discharged 4 days later. He again experienced lumbar pain 4 days post-discharge and was readmitted. Unenhanced CT scans of the abdomen and pelvis revealed a giant hematoma in the left psoas muscle and we suspected lumbar arterial injury. A preoperative aortography and transcatheter arterial coil embolization was then performed for the diagnosis and treatment of a lumbar artery pseudoaneurysm. On the preoperative angiography, pseudoaneurysm arising from the left lumbar artery was shown. All feeders were shown by the selective catheterization of the lumbar arteries and they were completely embolized using coils. However, contrast-enhanced CT obtained on the next day still demonstrated a pseudoaneurysm in the left psoas muscle. Thus, additional percutaneous embolization using N-butyl-2-cyanoacrylate was performed. After this procedure, complete embolization of the pseudoaneurysm was obtained and his lumbar pain was relieved.