Successful embolization of the left gastric artery aneurysm obtained in preoperative diagnosis: a report of 2 cases.

Gastric artery aneurysm is rare and accounts for fewer than 5% of all splanchnic artery aneurysms. The diagnosis is usually established during emergent surgery or at autopsy because warning signs or symptoms are vague, absent, or unrecognized. Nearly 80% of the patients reported with gastric artery aneurysm die. Preoperative diagnosis of gastric artery aneurysm is an essential contribution to treat safely and effectively the aneurysms and to reduce the high mortality rate. We report a successful treatment with transcatheter arterial embolization (TAE) of two cases of a left gastric artery aneurysm diagnosed using contrast-enhanced computed tomography. Case 1 was a ruptured aneurysm with shock. Embolization was successfully performed as the left gastric artery aneurysm was diagnosed by computed tomography at rupture. Case 2 had multiple hepatocellular carcinomas, and a left gastric artery aneurysm was diagnosed by follow-up computed tomography. Embolization was successfully performed for the left gastric artery aneurysm, and chemoembolization was repeatedly performed for multiple hepatocellular carcinomas after embolization of the aneurysm.

Successful Coil Embolization of an Aneurysm in the Arc of Bühler.

In the present report, we describe a case of a patient with an asymptomatic aneurysm in the arc of Bühler (AOB), which was successfully treated by transcatheter arterial embolization. The patient presented with severe stenosis of the celiac trunk, which was suspected to be due to median arcuate ligament syndrome. Arteriography of the superior mesenteric artery indicated a rapid stream in an aneurysm in the AOB. Hence, embolization was carefully performed using detachable coils and microcoils. An arteriography performed after embolization did not show any aneurysm, and the hepatic artery and splenic artery could be detected via the pancreatic arcade, originating from the superior mesenteric artery. The AOB is a persistent embryonic ventral anastomosis present between the superior mesenteric artery and the celiac artery. This anastomotic artery is independent of the gastroduodenal artery and the dorsal pancreatic artery, and is extremely rare, with an incidence of <4%. Aneurysms of the AOB are even more uncommon, and such cases have been reported in association with stenosis or occlusion of the celiac trunk. Open surgical aneurysmectomy, with or without reconstruction, is the conventional treatment for such aneurysms. However, rapid advances in interventional radiology have enabled the safe and effective treatment of visceral aneurysms via transcatheter arterial embolization. Based on the current findings, we believe that transcatheter arterial embolization is a minimally invasive and valuable method that may serve as an initial treatment option for aneurysms of the AOB.

Transcatheter arterial embolization of anomalous systemic arterial supply to the basal segment of the lung.

We describe the case of a 67-year-old woman with an anomalous systemic arterial supply to the basal segment of the lung, which was managed successfully by transcatheter arterial embolization (TAE) with microcoils. Her chest computed tomography (CT) scan showed diffuse ground-glass opacity in the left lower lobe, no bronchial abnormalities, and blood supply from an anomalous artery originating from the descending thoracic aorta, with drainage to the normal pulmonary vein. We successfully performed TAE under balloon occlusion of the anomalous artery, without complications. TAE is a minimally invasive, safe, and valuable method, and could be used as first-line treatment in such cases.