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Figure 1. A 60-year-old man underwent surgical repair of abdominal aortic aneurysm with a bifurcated graft complicated by proximal anastomotic pseudoaneurysm. (a) Enhanced CT obtained 6 months after surgery reveals a pseudoaneurysm 3.5 cm in diameter, inside of which pooling of contrast agents is seen (arrow) close to the proximal anastomosis. Note that the origin of the superior mesenteric artery is near the pseudoaneurysm (arrowhead). (b) Aortogram shows stenosis of proximal anastomosis (arrow) and pooling of the leaked contrast agents (arrowhead) from this anastomosis. (c) Image obtained while contrast material was being infused from a microcatheter that had been coaxially advanced to the inside of the pseudoaneurysm (arrow) via a 4-French catheter advanced into the aorta near the pseudoaneurysm. The entire pseudoaneurysm is shown. (d) Just after the procedure described in Figure 1c, the microcatheter was withdrawn once and the 4-French catheter was repositioned to be wedged to the neck of the pseudoaneurysm. This allowed blood flow in the pseudoaneurysm to decrease remarkably and part of interior of the pseudoaneurysm thrombosed spontaneously. The microcatheter was coaxially advanced again and the mixture of n-butyl cyanoacrylate and Lipiodol was inserted for embolisation. (e) Enhanced CT obtained 1.5 months after embolisation shows that the pseudoaneurysm is completely thrombosed (arrowhead). Note that Lipiodol infused at the time of embolisation by being mixed with n-butyl cyanoacrylate can be seen as a high density spot in the thrombosed pseudoaneurysm (arrow).
