Embedded Files
Welcome to the Academic and Educational pages of the
Department of Radiology
Seth G.S. Medical College and K.E.M. Hospital, Mumbai , India
Interventional Case Record
Interventional Case Record
Endovascular management of Rasmussen aneurysm using a vascular plug
Endovascular management of Rasmussen aneurysm using a vascular plug
Contributed by : Onkar Kanagi
Contributed by : Onkar Kanagi
Introduction:
Introduction:
A Rasmussen aneurysm (named aftrer Fritz Valdemar Rasmussen (1837–1877), a Danish physician, who first described the condition in 1868). is a rare, life-threatening pseudoaneurysmal dilatation of the pulmonary artery resulting from chronic, cavitary tuberculous inflammation that weakens the vessel wall [1]. This process of chronic inflammatory erosion typically occurs adjacent to or within a cavitary lesion, posing Two severe risk of life-threatening hemoptysis [1,2]. Given the high morbidity associated with rupture, endovascular embolization serves as a critical intervention, with vascular plugs emerging as a precise and effective tool for occluding the feeding arterial branches within this highly inflammatory environment [3,4,6]. These devices offer an advantage over traditional liquid embolics or coils by providing a durable, controlled seal that effectively isolates the pseudoaneurysm from the pulmonary circulation while preserving adjacent healthy lung parenchyma[5,6]. By facilitating stable, targeted vessel occlusion, these self-expanding nitinol devices minimize the risk of recanalization and provide a more definitive therapeutic solution for controlling high-pressure pulmonary hemorrhage [4,5,6]. Furthermore, the use of vascular plugs allows for high-radial force deployment, ensuring stable seating within the often tortuous vessels involved in mycobacterial cavitary destruction [7]. The implementation of these devices is particularly indicated in cases of active hemoptysis, where immediate isolation of the affected vessel is required to prevent fatal airway compromise [7,8].
A Rasmussen aneurysm (named aftrer Fritz Valdemar Rasmussen (1837–1877), a Danish physician, who first described the condition in 1868). is a rare, life-threatening pseudoaneurysmal dilatation of the pulmonary artery resulting from chronic, cavitary tuberculous inflammation that weakens the vessel wall [1]. This process of chronic inflammatory erosion typically occurs adjacent to or within a cavitary lesion, posing Two severe risk of life-threatening hemoptysis [1,2]. Given the high morbidity associated with rupture, endovascular embolization serves as a critical intervention, with vascular plugs emerging as a precise and effective tool for occluding the feeding arterial branches within this highly inflammatory environment [3,4,6]. These devices offer an advantage over traditional liquid embolics or coils by providing a durable, controlled seal that effectively isolates the pseudoaneurysm from the pulmonary circulation while preserving adjacent healthy lung parenchyma[5,6]. By facilitating stable, targeted vessel occlusion, these self-expanding nitinol devices minimize the risk of recanalization and provide a more definitive therapeutic solution for controlling high-pressure pulmonary hemorrhage [4,5,6]. Furthermore, the use of vascular plugs allows for high-radial force deployment, ensuring stable seating within the often tortuous vessels involved in mycobacterial cavitary destruction [7]. The implementation of these devices is particularly indicated in cases of active hemoptysis, where immediate isolation of the affected vessel is required to prevent fatal airway compromise [7,8].
Case presentation
Case presentation
A 53-year-old woman presented with right sided chest pain, grade II dyspnea, and productive cough of three weeks duration. This was associated with low grade fever with evening rise in temperature. She was type 2 diabetic being treated with insulin. She had no history of tuberculosis or tuberculous contact. The patient did not have any history of hemoptysis.
A 53-year-old woman presented with right sided chest pain, grade II dyspnea, and productive cough of three weeks duration. This was associated with low grade fever with evening rise in temperature. She was type 2 diabetic being treated with insulin. She had no history of tuberculosis or tuberculous contact. The patient did not have any history of hemoptysis.
At presentation, she was conscious and oriented, with pulse 100/min and SpO₂ 97% on room air.
At presentation, she was conscious and oriented, with pulse 100/min and SpO₂ 97% on room air.
The patient’s sputum was sent for GeneXpert MTB/RIF assay which was diagnostic of tuberculosis.
The patient’s sputum was sent for GeneXpert MTB/RIF assay which was diagnostic of tuberculosis.
Radiological findings:
Radiological findings:
CECT of the thorax demonstrated a large right upper lobe (RUL) Rasmussen aneurysm arising from segmental branch of right upper lobe pulmonary artery adjacent to the right upper lobe (RUL) bronchus. (Fig 1,2 & video 1). The surrounding RUL parenchyma showed consolidation, suggestive of active infective changes. The left upper lobe showed chronic post-infective sequelae.
CECT of the thorax demonstrated a large right upper lobe (RUL) Rasmussen aneurysm arising from segmental branch of right upper lobe pulmonary artery adjacent to the right upper lobe (RUL) bronchus. (Fig 1,2 & video 1). The surrounding RUL parenchyma showed consolidation, suggestive of active infective changes. The left upper lobe showed chronic post-infective sequelae.
CT Diagnosis: RUL Rasmussen aneurysm likely secondary to post-infective sequelae, associated with active infective changes.
CT Diagnosis: RUL Rasmussen aneurysm likely secondary to post-infective sequelae, associated with active infective changes.
Figure 1: Axial CT pulmonary angiography (CTPA) showing right upper lobe (RUL) Rasmussen aneurysm.
Figure 2 Oblique coronal CTPA showing Rasmussen aneurysm in right upper lobe arising from segmental branch of right upper lobar artery
vid 1.mp4Video 1 : Pre-procedure CTPA demonstrating RUL Rasmussen aneurysm.
The patient was referred to Interventional Radiology for endovascular management of the RUL Rasmussen aneurysm. In view of the above CT findings and risk of massive hemopt, a decision of performing selective pulmonary angiography followed by vascular plug embolization was made.
The patient was referred to Interventional Radiology for endovascular management of the RUL Rasmussen aneurysm. In view of the above CT findings and risk of massive hemopt, a decision of performing selective pulmonary angiography followed by vascular plug embolization was made.
Interventional technique :
Interventional technique :
The procedure was performed under monitored anaesthesia care and with all aseptic precautions.
The procedure was performed under monitored anaesthesia care and with all aseptic precautions.
The right common femoral vein was accessed using 7 Fr vascular sheath.
The right common femoral vein was accessed using 7 Fr vascular sheath.
Selective catheterization of the main pulmonary artery and the right pulmonary artery was achieved using 4 Fr pigtail catheter and angiograms obtained.
Selective catheterization of the main pulmonary artery and the right pulmonary artery was achieved using 4 Fr pigtail catheter and angiograms obtained.
These showed large a pseudoaneurysm (Rasmussen aneurysm) arising from a segmental branch of the right upper lobe pulmonary artery, corresponding to the lesion seen on CTPA. (fig 3,4 & video 2,3)
These showed large a pseudoaneurysm (Rasmussen aneurysm) arising from a segmental branch of the right upper lobe pulmonary artery, corresponding to the lesion seen on CTPA. (fig 3,4 & video 2,3)
Fig 3: Main pulmonary artery digital subtraction angiography image demonstrating RUL Rasmussen aneurysm.
Fig 4: Right pulmonary artery digital subtraction angiography image demonstrating RUL Rasmussen aneurysm.
vid 2.mp4vid 3.mp4Video 2: Main pulmonary artery DSA demonstrating RUL Rasmussen aneurysm.
Video 3: Right pulmonary artery DSA demonstrating RUL Rasmussen aneurysm.
The vascular access was secured with stiff guidewire, which was advanced beyond the right upper lobar artery into the right interlobar artery. The short vascular sheath was subsequently exchanged for a 9F x 90cm long sheath (fig 5).
The vascular access was secured with stiff guidewire, which was advanced beyond the right upper lobar artery into the right interlobar artery. The short vascular sheath was subsequently exchanged for a 9F x 90cm long sheath (fig 5).
Selective catheterization of the affected segmental branch of right upper lobar artery was performed using a 7F H1 envoy catheter (fig 6). Contrast injection through this catheter showed opacification of the aneurysmal sac (fig 6 & video 4).
Selective catheterization of the affected segmental branch of right upper lobar artery was performed using a 7F H1 envoy catheter (fig 6). Contrast injection through this catheter showed opacification of the aneurysmal sac (fig 6 & video 4).
Fig 5: DSA image showing long sheath placed beyond the upper lobar branch of right pulmonary artery with its tip in interlobar pulmonary artery.
Fig 6: DSA image showing selective cannulation of the segmental branch of right upper lobar artery using H1 envoy catheter.
vid 4.mp4Video 4: Selective DSA of the culprit segmental pulmonary arterial branch demonstrating the pseudoaneurysm.
An 8mm x 7mm Amplatz type II vascular plug was deployed across the feeding arterial branch, with adequate positioning and expansion (video 5).
An 8mm x 7mm Amplatz type II vascular plug was deployed across the feeding arterial branch, with adequate positioning and expansion (video 5).
Post procedure angiogram revealed complete exclusion of the pseudoaneurysm with no residual filling. Flow in remaining right upper lobe pulmonary arterial branches was normal (video 6,7).
Post procedure angiogram revealed complete exclusion of the pseudoaneurysm with no residual filling. Flow in remaining right upper lobe pulmonary arterial branches was normal (video 6,7).
vid 6.mp4vid 7.mp4Video 6: Post procedure DSA showing no residual filling of pseudoaneurysm
Video 7: Post procedure DSA showing no residual filling of pseudoaneurysm with preservation of flow in the remaining right upper lobe pulmonary arterial branches
Post procedure course and follow-up
Post procedure course and follow-up
The patient tolerated the endovascular procedure well, with no immediate post procedure related complications. Following embolization, there was significant reduction in patient’s chest pain. There were no episodes of hemoptysis. The patient was started on appropriate anti-tubercular drugs.
The patient tolerated the endovascular procedure well, with no immediate post procedure related complications. Following embolization, there was significant reduction in patient’s chest pain. There were no episodes of hemoptysis. The patient was started on appropriate anti-tubercular drugs.
Post procedure CT pulmonary angiography demonstrated satisfactory deployment of Amplatz vascular plug within segmental branch of right upper lobar pulmonary artery, with no residual contrast enhancement within the pseudoaneurysm. The pseudoaneurysm demonstrated partial thrombosis following embolization (fig 7, 8 & video 8)
Post procedure CT pulmonary angiography demonstrated satisfactory deployment of Amplatz vascular plug within segmental branch of right upper lobar pulmonary artery, with no residual contrast enhancement within the pseudoaneurysm. The pseudoaneurysm demonstrated partial thrombosis following embolization (fig 7, 8 & video 8)
Figure 7 Post procedure axial CTPA demonstrating no residual contrast enhancement within the pseudoaneurysm.
Figure 8: Post procedure DSA showing no residual filling of pseudoaneurysm with preservation of flow in the remaining right upper lobe pulmonary arterial branches.
vid 8.mp4Video 8: Post procedure CTPA demonstrating satisfactory deployment of Amplatz vascular plug within segmental branch of right upper lobar pulmonary artery, with no residual contrast enhancement within the pseudoaneurysm.
Discussion
Discussion
A Rasmussen aneurysm is a rare complication of chronic pulmonary tuberculosis. characterized as a pseudoaneurysmal dilatation of a pulmonary artery branch adjacent to or within a tuberculous cavity [1].
A Rasmussen aneurysm is a rare complication of chronic pulmonary tuberculosis. characterized as a pseudoaneurysmal dilatation of a pulmonary artery branch adjacent to or within a tuberculous cavity [1].
Chronic, destructive tuberculous inflammation within a cavitary lesion progressively invades the adventitia and media of adjacent subsegmental or segmental pulmonary arterial branches. replacing structural smooth muscle and elastic fibers with fibrin leading to pseudoaneurysm formation [2,3,4].
Chronic, destructive tuberculous inflammation within a cavitary lesion progressively invades the adventitia and media of adjacent subsegmental or segmental pulmonary arterial branches. replacing structural smooth muscle and elastic fibers with fibrin leading to pseudoaneurysm formation [2,3,4].
Computed Tomography Pulmonary Angiography (CTPA) serves as the primary gold-standard diagnostic imaging modality to identify a Rasmussen aneurysm [5].
Computed Tomography Pulmonary Angiography (CTPA) serves as the primary gold-standard diagnostic imaging modality to identify a Rasmussen aneurysm [5].
Precise pre-procedural identification of the feeding pulmonary arterial branch via thin-section CTPA is essential for guiding subsequent transcatheter intervention [5,6].
Precise pre-procedural identification of the feeding pulmonary arterial branch via thin-section CTPA is essential for guiding subsequent transcatheter intervention [5,6].
Surgical pulmonary resection for Rasmussen aneurysm carries high morbidity and operative mortality [7,8]. Consequently, minimally invasive endovascular catheter-directed therapy has emerged as the definitive standard of care [9,10,11]. The selection of the embolic agent must take into consideration vessel diameter, landing zone dimensions, vascular tortuosity, and local blood flow velocity [12].
Surgical pulmonary resection for Rasmussen aneurysm carries high morbidity and operative mortality [7,8]. Consequently, minimally invasive endovascular catheter-directed therapy has emerged as the definitive standard of care [9,10,11]. The selection of the embolic agent must take into consideration vessel diameter, landing zone dimensions, vascular tortuosity, and local blood flow velocity [12].
While coil embolization remains a widely utilized technique, it is associated with risk of coil compaction, vessel perforation, and delayed endobronchial migration [9, 12,13]. Conversely, self-expanding nitinol vascular plugs distribute uniform radial outward force over an extended longitudinal length, achieving vessel cross-sectional occlusion while reducing focal shear stress on the hyper-fragile vessel wall [9,13].
While coil embolization remains a widely utilized technique, it is associated with risk of coil compaction, vessel perforation, and delayed endobronchial migration [9, 12,13]. Conversely, self-expanding nitinol vascular plugs distribute uniform radial outward force over an extended longitudinal length, achieving vessel cross-sectional occlusion while reducing focal shear stress on the hyper-fragile vessel wall [9,13].
The Amplatzer Vascular Plug (AVP) consists of self-expanding, braided nitinol wire mesh device attached via a micro-screw interface to a 155-cm PTFE-coated delivery wire, enabling complete controlled deployment, angiographic evaluation, and full retrieval or repositioning if placement is suboptimal [14,15].
The Amplatzer Vascular Plug (AVP) consists of self-expanding, braided nitinol wire mesh device attached via a micro-screw interface to a 155-cm PTFE-coated delivery wire, enabling complete controlled deployment, angiographic evaluation, and full retrieval or repositioning if placement is suboptimal [14,15].
Accurate device sizing is critical to prevent procedural failure, requiring cross-sectional measurements of the non-diseased pulmonary arterial feeding segment proximal to the pseudoaneurysm via thin-section CTPA and intra-procedural digital subtraction angiography (DSA) calibrated with radiopaque marker catheters [15,16]. Interventional guidelines mandate 30% to 50% oversizing for AVP I and AVP II devices. [16]
Accurate device sizing is critical to prevent procedural failure, requiring cross-sectional measurements of the non-diseased pulmonary arterial feeding segment proximal to the pseudoaneurysm via thin-section CTPA and intra-procedural digital subtraction angiography (DSA) calibrated with radiopaque marker catheters [15,16]. Interventional guidelines mandate 30% to 50% oversizing for AVP I and AVP II devices. [16]
A critical technical pitfall in pseudoaneurysm management is relying solely on isolated proximal inflow occlusion [17,18]. Because the pulmonary circulation features extensive inter-segmental anastomotic networks and localized hypoxia triggers neo-vascularization from systemic collaterals retrograde flow will continue to fill the pseudoaneurysm sac if distal outflow is left unoccluded [16,19].
A critical technical pitfall in pseudoaneurysm management is relying solely on isolated proximal inflow occlusion [17,18]. Because the pulmonary circulation features extensive inter-segmental anastomotic networks and localized hypoxia triggers neo-vascularization from systemic collaterals retrograde flow will continue to fill the pseudoaneurysm sac if distal outflow is left unoccluded [16,19].
To eliminate collateral back-bleeding, interventional radiologists must execute the sandwich technique (inflow and outflow exclusion) [19,20] and hybrid embolization strategies—such as plug-assisted liquid embolization [21].
To eliminate collateral back-bleeding, interventional radiologists must execute the sandwich technique (inflow and outflow exclusion) [19,20] and hybrid embolization strategies—such as plug-assisted liquid embolization [21].
Endovascular treatment of pulmonary artery pseudoaneurysms yields high technical success rates (85% to 95%), with immediate clinical control of hemoptysis achieved in over 90% of cases. Potential post-procedural complications include limited wedge-shaped pulmonary infarction, non-target embolization, and rare endobronchial hardware erosion in extensively necrotizing cavities [13,14].
Endovascular treatment of pulmonary artery pseudoaneurysms yields high technical success rates (85% to 95%), with immediate clinical control of hemoptysis achieved in over 90% of cases. Potential post-procedural complications include limited wedge-shaped pulmonary infarction, non-target embolization, and rare endobronchial hardware erosion in extensively necrotizing cavities [13,14].
Conclusion
Conclusion
Rasmussen aneurysms are high-risk pulmonary artery pseudoaneurysms that present a significant risk of fatal hemoptysis due to inflammatory vessel wall destruction and transmural rupture. Minimally invasive endovascular therapy is the definitive management strategy [1,11,12]. Vascular plugs offer major mechanical advantages over traditional coils, providing precise single-device vessel occlusion, low migration risk, controlled delivery, and full retrievability prior to release [15,16,17].
Rasmussen aneurysms are high-risk pulmonary artery pseudoaneurysms that present a significant risk of fatal hemoptysis due to inflammatory vessel wall destruction and transmural rupture. Minimally invasive endovascular therapy is the definitive management strategy [1,11,12]. Vascular plugs offer major mechanical advantages over traditional coils, providing precise single-device vessel occlusion, low migration risk, controlled delivery, and full retrievability prior to release [15,16,17].
Achieving optimal outcomes depends on careful adherence to key interventional radiology principles: oversizing the plug by 30% to 50% relative to the parent vessel diameter to accommodate inflammatory wall hyper-compliance [16,18], deploying embolic agents using the inflow and outflow "sandwich" technique to prevent collateral re-pressurization [19,20], and utilizing hybrid liquid embolic agents when immediate hemostasis is required [13,21]. When integrated with complete anti-tubercular medical therapy and structured follow-up imaging, vascular plug embolization provides safe, reliable, and durable exclusion of Rasmussen aneurysms, significantly reducing morbidity and mortality from massive intrapulmonary hemorrhage [1,4,22].
Achieving optimal outcomes depends on careful adherence to key interventional radiology principles: oversizing the plug by 30% to 50% relative to the parent vessel diameter to accommodate inflammatory wall hyper-compliance [16,18], deploying embolic agents using the inflow and outflow "sandwich" technique to prevent collateral re-pressurization [19,20], and utilizing hybrid liquid embolic agents when immediate hemostasis is required [13,21]. When integrated with complete anti-tubercular medical therapy and structured follow-up imaging, vascular plug embolization provides safe, reliable, and durable exclusion of Rasmussen aneurysms, significantly reducing morbidity and mortality from massive intrapulmonary hemorrhage [1,4,22].
References
References
1. Santelli ED, Katz DS, Goldschmidt AM, Thomas HA. Embolization of Rasmussen's aneurysm: Report of two cases. AJR Am J Roentgenol. 1997;169(2):413-416.
1. Santelli ED, Katz DS, Goldschmidt AM, Thomas HA. Embolization of Rasmussen's aneurysm: Report of two cases. AJR Am J Roentgenol. 1997;169(2):413-416.
2. Shin S, Shin TB, Choi SY, et al. Endovascular management of pulmonary artery pseudoaneurysms: A single-center experience and review of technical strategies. J Clin Med. 2023;12(11):3796.
2. Shin S, Shin TB, Choi SY, et al. Endovascular management of pulmonary artery pseudoaneurysms: A single-center experience and review of technical strategies. J Clin Med. 2023;12(11):3796.
3. Chen Y, Gilman MD, Humphrey KL, et al. Pulmonary artery pseudoaneurysms: Clinical features and endovascular management. AJR Am J Roentgenol. 2017;208(1):84-91.
3. Chen Y, Gilman MD, Humphrey KL, et al. Pulmonary artery pseudoaneurysms: Clinical features and endovascular management. AJR Am J Roentgenol. 2017;208(1):84-91.
4. Gupta M, Ahluwalia C, Mahajan A, et al. Rasmussen aneurysm in pulmonary tuberculosis: Pathophysiology, diagnostic evaluation, and endovascular management. Respir Med Case Rep. 2021;34:101519.
4. Gupta M, Ahluwalia C, Mahajan A, et al. Rasmussen aneurysm in pulmonary tuberculosis: Pathophysiology, diagnostic evaluation, and endovascular management. Respir Med Case Rep. 2021;34:101519.
5. Ramakantan R, Bandiske M, Shah P, et al. Transcatheter embolization of pulmonary artery pseudoaneurysms in tuberculous cavitary lung disease. Australas Radiol. 1996;40(3):255-259.
5. Ramakantan R, Bandiske M, Shah P, et al. Transcatheter embolization of pulmonary artery pseudoaneurysms in tuberculous cavitary lung disease. Australas Radiol. 1996;40(3):255-259.
6. Khalil A, Parrot A, Fartoukh M, et al. Pulmonary artery occlusion in hemoptysis: Indications, techniques, and results. AJR Am J Roentgenol. 2010;195(3):751-756.
6. Khalil A, Parrot A, Fartoukh M, et al. Pulmonary artery occlusion in hemoptysis: Indications, techniques, and results. AJR Am J Roentgenol. 2010;195(3):751-756.
7. Lordan JL, Gascoigne A, Corris PA. Assessment and management of massive haemoptysis. Thorax. 2003;58(9):814-819.
7. Lordan JL, Gascoigne A, Corris PA. Assessment and management of massive haemoptysis. Thorax. 2003;58(9):814-819.
8. Jean-Baptiste E. Clinical assessment and management of massive hemoptysis. Crit Care Med. 2000;28(5):1642-1647.
8. Jean-Baptiste E. Clinical assessment and management of massive hemoptysis. Crit Care Med. 2000;28(5):1642-1647.
9. Remy J, Remy-Jardin M, Voisin C. Endovascular management of severe hemoptysis in pulmonary tuberculosis. Radiology. 1998;208(2):321-331.
9. Remy J, Remy-Jardin M, Voisin C. Endovascular management of severe hemoptysis in pulmonary tuberculosis. Radiology. 1998;208(2):321-331.
10. Chun JY, Morgan R, Belli AM. Endovascular management of pulmonary artery pseudoaneurysms and aneurysms. Cardiovasc Intervent Radiol. 2010;33(2):236-247.
10. Chun JY, Morgan R, Belli AM. Endovascular management of pulmonary artery pseudoaneurysms and aneurysms. Cardiovasc Intervent Radiol. 2010;33(2):236-247.
11. Pilate L, Zhang J, Morris C, et al. Multi-detector CT pulmonary angiography in the diagnosis and treatment planning of Rasmussen aneurysm. Pol Ann Med. 2022;29(2):145-151.
11. Pilate L, Zhang J, Morris C, et al. Multi-detector CT pulmonary angiography in the diagnosis and treatment planning of Rasmussen aneurysm. Pol Ann Med. 2022;29(2):145-151.
12. Park A, Cwikiel W. Endovascular treatment of pulmonary artery pseudoaneurysms using Amplatzer vascular plugs and coils. J Vasc Interv Radiol. 2008;19(11):1641-1646.
12. Park A, Cwikiel W. Endovascular treatment of pulmonary artery pseudoaneurysms using Amplatzer vascular plugs and coils. J Vasc Interv Radiol. 2008;19(11):1641-1646.
13. Sbitti Y, Debbagh A, Bellaharrak A, et al. Complications and technical pitfalls in embolization of tuberculous pulmonary pseudoaneurysms. Case Rep Radiol. 2019;2019:8492015.
13. Sbitti Y, Debbagh A, Bellaharrak A, et al. Complications and technical pitfalls in embolization of tuberculous pulmonary pseudoaneurysms. Case Rep Radiol. 2019;2019:8492015.
14. Gwon DI, Ko GY, Kim JH, et al. Technical limitations and complication profile of coil embolization in necrotizing lung lesions. Korean J Radiol. 2013;14(2):246-253.
14. Gwon DI, Ko GY, Kim JH, et al. Technical limitations and complication profile of coil embolization in necrotizing lung lesions. Korean J Radiol. 2013;14(2):246-253.
15. Tresley J, Bhatia S, Kably I, Poozhikunnath Mohan P, Salsamendi J, Narayanan G. Amplatzer vascular plug as an embolic agent in different vascular pathologies: A pictorial essay. Indian J Radiol Imaging. 2016;26(2):254-261.
15. Tresley J, Bhatia S, Kably I, Poozhikunnath Mohan P, Salsamendi J, Narayanan G. Amplatzer vascular plug as an embolic agent in different vascular pathologies: A pictorial essay. Indian J Radiol Imaging. 2016;26(2):254-261.
16. Lopera JE. The Amplatzer Vascular Plug: Review of evolution and current applications. Cardiovasc Intervent Radiol. 2015;38(2):262-274.
16. Lopera JE. The Amplatzer Vascular Plug: Review of evolution and current applications. Cardiovasc Intervent Radiol. 2015;38(2):262-274.
17. Zhu X, Tam MD, Pierce G, et al. Utility of the Amplatzer Vascular Plug IV in distal tortuous vascular beds: Technical notes and clinical applications. J Vasc Interv Radiol. 2012;23(8):1093-1098.
17. Zhu X, Tam MD, Pierce G, et al. Utility of the Amplatzer Vascular Plug IV in distal tortuous vascular beds: Technical notes and clinical applications. J Vasc Interv Radiol. 2012;23(8):1093-1098.
18. Kundaragi NG, et al. Endovascular treatment of pulmonary artery pseudoaneurysms using Amplatzer vascular plug IV and coils. J Clin Interv Radiol ISVIR. 2023;7(1):46-50.
18. Kundaragi NG, et al. Endovascular treatment of pulmonary artery pseudoaneurysms using Amplatzer vascular plug IV and coils. J Clin Interv Radiol ISVIR. 2023;7(1):46-50.
19. Ferro C, Rossi UG, Bovio G, et al. Principles of inflow and outflow vessel occlusion in pseudoaneurysms: Avoidance of collateral re-pressurization. Vasc Endovascular Surg. 2014;48(5):389-395.
19. Ferro C, Rossi UG, Bovio G, et al. Principles of inflow and outflow vessel occlusion in pseudoaneurysms: Avoidance of collateral re-pressurization. Vasc Endovascular Surg. 2014;48(5):389-395.
20. Keeling AN, Naughton PA, Leahy AL, et al. The "sandwich" technique for endovascular exclusion of visceral and pulmonary pseudoaneurysms. Eur J Vasc Endovasc Surg. 2009;38(3):340-344.
20. Keeling AN, Naughton PA, Leahy AL, et al. The "sandwich" technique for endovascular exclusion of visceral and pulmonary pseudoaneurysms. Eur J Vasc Endovasc Surg. 2009;38(3):340-344.
21. Keeling AN, et al. Hybrid embolization strategies with N-butyl-2-cyanoacrylate glue and vascular plugs in pulmonary arterial lesions. J Vasc Interv Radiol. 2013;24(3):350-358.
21. Keeling AN, et al. Hybrid embolization strategies with N-butyl-2-cyanoacrylate glue and vascular plugs in pulmonary arterial lesions. J Vasc Interv Radiol. 2013;24(3):350-358.
22. Binsaleh S, Al-Ahmadi M. Outcomes of transcatheter embolization for pulmonary artery pseudoaneurysms: A systematic review. Ann Vasc Surg. 2020;66:412-420.
22. Binsaleh S, Al-Ahmadi M. Outcomes of transcatheter embolization for pulmonary artery pseudoaneurysms: A systematic review. Ann Vasc Surg. 2020;66:412-420.
Google Sites
Report abuse