PMC3350133_01
25-years-old male patient with SMA pseudoaneurysm. Transverse CT scan in delayed venous phase (45 seconds), slice thickness showing oval hyper vascular lesion between aorta and inferior vena cava 27 mm in diameter.
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fig1
Multislice computed tomography (MSCT) angiography of the abdomen revealed a rounded hyperdense lesion 27 mm in diameter filled with contrast medium in early arterial phase of imaging, and this confirmed the diagnosis of pseudoaneurysms located next to the ostium of superior mesenteric artery (SMA) (Figures 1 and 2).
Coronal MPR MSCT angiography showing pseudoaneurysm and occlusion of part of SMA.
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fig2
Multislice computed tomography (MSCT) angiography of the abdomen revealed a rounded hyperdense lesion 27 mm in diameter filled with contrast medium in early arterial phase of imaging, and this confirmed the diagnosis of pseudoaneurysms located next to the ostium of superior mesenteric artery (SMA) (Figures 1 and 2).
Selective angiography of SMA showing pseudoaneurysm, occlusion of short part of SMA and patent SMA below pseudoaneurysms, (a) inferior pancreaticoduodenal artery, (b) inferior pancreaticoduodenal artery branches, (c) short neck of artery filling pseudoaneurysm, and (d) distal part of SMA.
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fig3
SMA distal to origin of replaced right HA revealed an pseudoaneurysm filling from branch of inferior pancreaticoduodenal artery, occlusion of main SMA trunk at the level of pseudoaneurysm, and collateral filling with patent SMA distal to pseudoaneurysm (Figure 3). Superselective angiogram of branch of the inferior pancreaticoduodenal artery filling the pseudoaneurysm showed no communication with other arteries or extravasation in peritoneal space (Figure 4). 
Superselective angiography through the feeding artery (aneurysmography), showing no vessels arising from pseudoaneurysms.
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fig4
SMA distal to origin of replaced right HA revealed an pseudoaneurysm filling from branch of inferior pancreaticoduodenal artery, occlusion of main SMA trunk at the level of pseudoaneurysm, and collateral filling with patent SMA distal to pseudoaneurysm (Figure 3). Superselective angiogram of branch of the inferior pancreaticoduodenal artery filling the pseudoaneurysm showed no communication with other arteries or extravasation in peritoneal space (Figure 4). 
(b) "safe" guide wire in the main trunk of inferior pancreaticoduodenal artery, visualisation of replaced right hepatic artery, and filling of pseudoaneurysm.
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fig5
N.V. Netherlands), and additional "safe" 0.014'' guide wire positioned in the main tree of inferior pancreaticoduodenal artery, allowing for additional stabilization of the system and to have wire in place in case of inadvertent embolisation (Figure 5).
postembolisation angiogram showing complete exclusion of pseudoaneurysm without contrast filling. (a) coils within lumen, (b) postocclusive SMA, (c) patent inferior pancreaticoduodenal artery, (d) replaced right hepatic artery, and (e) branches of inferior pancreaticoduodenal artery.
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fig6
Fla, USA, USA) 3 mm x 40 mm were inserted in the pseudoaneurysm's neck. Follow-up DSA showed total occlusion of the pseudoaneurysm's neck without the need for additional coils and with the preserved blood flow in the main trunk of inferior pancreaticoduodenal artery (Figure 6).
CT scan 24 hours post embolisation in delayed venous phase (45 sec), collimation 5 mm showing complete thrombosis of pseudoaneurysm. Hyperdense small round object (arrow) consistent with coils.
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fig7
Follow-up USCD and MSCT 24 hrs later showed a complete thrombosis of SMA pseudoaneurysm (Figure 7).