Transarterial Embolization of Pseudoaneurysm Using Femoral Artery Approach

This is a case of a 11yr old boy who presented to emergency with alleged history of RTA (a two-wheeler ran over abdomen and chest) after five hours of the incident. On presentation, the patient was pale and had tachycardia (170/ min), hypotension (80/50 mm of Hg), and GCS 15/15 with no major external injuries other than a few small abrasions over the abdomen. After resuscitation with intravenous fluids, the patient was evaluated for intra-abdominal and chest injuries with CECT –abdomen & pelvis and CT chest.

Contrast-enhanced CT of abdomen and pelvis revealed Grade IV liner laceration involving segments VI & VII of Right lobe of liver with 11 X 10mm pseudoaneurysm noted in segment VI/ VII of liver arising from post sectoral branch of right hepatic artery.

In view of low Hb (6.3 g/dl) patient was transfused with two unit PRBC, following tachycardia has come down to 120/min, blood pressure stabilized at 100/60 mm of Hg.

After stabilization, the patient was taken for transarterial embolization of pseudoaneurysm through the right femoral artery approach. Post-procedural angiogram revealed no flow into pseudoaneurysm and retained normal flow to the rest of the branches of the right and left hepatic arteries. Post-procedure period was uneventful.

Another unit of PRBC was transfused on the next day as the patient had low Hb (7.5 g/dl). Patient had developed breathlessness with tachypnea and drop in saturation, started on O2 supplementation, chest x-ray was done which revealed elevation of right hemi diaphragm. Patient was advised incentive spirometry exercises and chest physiotherapy however the patient had worsening saturation hence the O2 supplementation was increased.

Chest X-ray was repeated which showed blunting of right costophrenic angle, USG thorax was done which showed mild B/L pleural effusion (Right> Left). Pulmonologist opinion was taken and patient was encouraged to do incentive spirometry, fluid restriction and diuretics. Patient improved symptomatically, O2 supplementation was stopped, later the patient was shifted to general ward and was discharged the following day in stable condition.