PMC6159298_01
Digital subtraction angiography image of the left lower limb (anteroposterior view) showing the pseudoaneurysm (short arrow) arising from the middle of the saphenous vein (long arrow) graft without leak from the anastomotic site.
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fig1
Because of the suspicion of an anastomotic leak, digital subtraction angiography (DSA) was performed in the interventional radiology suite via the contralateral common femoral artery retrograde access using a 4 French sheath and 4 French Cobra catheter (Cook Medical, Bloomington, IN) which showed a pseudoaneurysm (Figure 1) that had developed owing to a leak from one of the tributaries of the saphenous vein that was used as graft; also there was no adequate flow from the posterior tibial artery and the peroneal artery (Figure 1).
Digital substraction angiography image of the left lower limb (anteroposterior view) showing the tip of the microcatheter (long arrow) with injection of glue into the neck of the pseudoaneurysm (short arrow).
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fig2
Digital subtraction angiography image of the left lower limb (anteroposterior view) showing formation of the complete glue cast (arrow).
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fig3
Sheffield, UK) by mixing 1 ml of glue with 2 ml of Lipiodol (Guerbet LLC, Bloomington, IN)] into the neck of the pseudoaneurysm after flushing the microcatheters with 5% dextrose solution. Soon a complete glue cast (Figure 3) formed inside the pseudoaneurysm and the microcatheter was pulled out by yanking.
Digital subtraction angiography image of the left lower limb (anteroposterior view) showing complete exclusion of the pseudoaneurysm (arrow) from the circulation with good distal runoff in the dorsalis pedis.
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fig4
Post-embolization check DSA showed complete exclusion of the pseudoaneurysm from the circulation with good antegrade flow into the DPA (Figure 4).