Use of transradial access to install two sequential stents for pseudoaneurysms along the celiac artery and common hepatic artery axes: A case report

Abstract

Abstract Background Transfemoral access (TFA) is the usual method for stenting visceral aneurysms. Here, we utilized transradial access (TRA) to sequentially place two stents for pseudoaneurysms in the celiac artery (CA) and common hepatic artery (CHA). Case Presentation 58-yo male with pancreatic cancer s/p distal pancreatectomy presents with decreasing hemoglobin. Imaging showed evidence of intraperitoneal bleeding secondary to CA and CHA pseudoaneurysms. Due to coagulopathic concerns, stenting was pursued along these axes via TRA. Left radial artery (RA) sonogram revealed a Barbeau B waveform. After the left RA was accessed, a 5-Fr slender sheath was placed over a 0.018 wire. Over Bentson wire, a 5-Fr pigtail catheter was then placed into the abdominal aorta. Next, a catheter was exchanged over wire for a 5-Fr Ultimate catheter, and the superior mesenteric artery was selected, followed by the CA. Truselect microcatheter, assisted by fathom wire, was then placed into the CHA and right hepatic artery (HA). A microcatheter was placed deep into the right HA branch; a V18 exchange-length wire was placed through the microcatheter into that branch. A 6-Fr radial sheath was placed over the wire. Two 6mm x 5cm covered self-expanding Viabahn stents were then sequentially placed. The first stent covered the pseudoaneurysm in the CHA; the second stent extended from the first into the celiac axis. An Ultimate catheter was later placed in the celiac axis. Post-stenting arteriogram and angiogram revealed patent stents in the CA and CHA, with no evidence of active arterial extravasation. Conclusion TRA may be valuable in stenting visceral aneurysms/pseudoaneurysms.