Visceral artery aneurysms are relatively rare, but are found incidentally owing to recent advances in diagnostic imaging. Ruptured aneurysms have a high mortality rate because they are difficult to treat, requiring reliable endovascular interventions. In recent years, transcatheter arterial embolization, which is associated with low invasiveness, a low complication rate, and a high success rate, has become the first choice of treatment for visceral artery aneurysms. However, surgical treatment is necessary if endovascular treatment is difficult. In this paper, we report the main indications and strategies for treating visceral artery aneurysms.

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Visceral artery aneurysms and pseudoaneurysms are rare but potentially lethal, and endovascular treatments are often selected for indicated cases. Embolization of the parent artery by the isolation method is often necessary for endovascular treatment, and the embolization must sometimes be completed within the target regions in spite of a high blood flow and relatively large diameter. In such a case, coil embolization using a balloon catheter is useful because it enables control of the blood flow and coil placement site.

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We describe the methods, recommended indications for, and latest opinions regarding balloon assisted coil embolization for visceral artery aneurysms. Balloon assist technique should be considered, when the aneurysmal neck is wide, the aneurysm is large and the aneurysm has a complex shape. There are 3 techniques: balloon assisted technique, double balloon assisted technique and balloon assisted double catheter technique.

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Visceral arterial aneurysms (VAAs) are rare with a prevalence of 0.1%-2%. VAAs carry a definite risk of rupture, which varies infrequency between 3% and 10%, depending on the aneurysm size and location; when these aneurysms rupture, they are fatal in 20% to 100% of patients. Recently, transcatheter arterial embolization including coil packing or isolation for VAAs has been widely used as a treatment alternative to surgical ligation. However, the VAAs sometimes have a large neck, and often involve a few branches at the neck or trunk. Therefore, the adjunctive techniques including multiple catheter technique, or balloon- or stent- assist technique should be required for safe and sufficiently tight packing of the aneurysmal lumen while preserving the parent artery and branches. Stent graft is an alternative technique of excluding VAAs while preserving the parent artery. So, a wide-neck aneurysm is no longer a contraindication for endovascular treatment when a combination of adjunctive techniques in used. In this article, we present a pictorial review of various kinds of adjunctive technique especially focusing on the stent assisted coil packing of VAAs.

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Flow diverters (FDs) have recently been developed as innovative endovascular devices to treat unruptured intracranial aneurysms. FDs can alter and reduce the blood flow into the aneurysmal sac and subsequently induce progressive aneurysmal thrombosis while preserving the patency of the surrounding small vessels and perforators. Therefore FD therapy is superior to conventional endosaccular coil embolization with its high complete occlusion rate and low risk of recurrence. Because there are risks of morbidity and neurological mortality, appropriate case selection and procedures performed by skillful physicians are mandatory for the effective use of FDs.

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A woman in her 50s was hit by a truck and injured while riding a bicycle. Transcatheter arterial embolization was carried out for a large hematoma with unstable pelvic fracture. Right internal iliac arteriography showed the uterine artery and lateral sacral artery, but the distal part of the right internal iliac artery was occluded. Considering the risk of re-bleeding due to vessel injury and abnormal coagulation and fibrinolytic function, we embolized the main trunk of the right internal iliac artery using 25% NBCA.
Acute traumatic occlusion of the internal iliac artery is rare, and it is unknown whether it requires IVR. Embolization to prevent re-bleeding associated with hyperfibrinolysis may be potentially useful, though further consideration is needed.

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Polycystic liver disease (PLD) may cause portal vein obstruction and portal hypertension. A woman in her 50s was admitted for hepatic encephalopathy (HE) and esophageal varices (EV). Contrast-enhanced CT revealed severe portal vein stenosis and thrombosis which were associated with compression of the right portal vein by hepatic large cysts at the hepatic hilum. CT-guided drainage of hilar hepatic cysts followed by ethanol sclerotherapy was performed. HE was immediately resolved, and endoscopic variceal ligation was added. Resolution of HE and EV has continued for 21 months. We report a patient with PLD whose symptomatic portal hypertension was successfully treated with percutaneous drainage and ethanol sclerotherapy.

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