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Fig. 1 | CVIR Endovascular

Fig. 1

From: Left omental artery bleeding in two patients with segmental arterial mediolysis successfully isolated with coil embolization

Fig. 1

Images from a 55-year-old man with left omental artery (OA) bleeding associated with segmental arterial mediolysis (SAM). a Axial contrast-enhanced computed tomography (CT) reveals massive intraperitoneal high-density ascites mainly involving the left portion of the greater omentum (arrows) where the OA with the dilated, stenotic change develops the possible hematoma (arrowheads). b Coronal volume-rendered image from CT in the cranial and left anterior oblique projection reveals that the left OA (arrows) arising acutely from a splenic artery branch and coursing away from the greater curvature develops dilated, stenotic change (dotted circle) and that the potential bleeding site at the distal portion of left OA (arrowhead) is far from celiac artery. SAM is the most likely diagnosis, and transarterial embolization is planned. c Photograph of the triaxial catheter system consisting of a 4.2 Fr shepherd’s hook catheter, a 2.8 Fr high-flow microcatheter and a 2.0 Fr microcatheter, which serves as the outermost, intermediate, and innermost catheters, respectively. d Digital subtraction angiography (DSA) of the left OA in posteroanterior projection using the triaxial catheter reveals a pseudoaneurysm in the distal portion (white arrow). Note an intact distal left. OA runs through (white arrowheads). Coil embolization is planned to isolate the proximal and distal artery (black dotted circle). Note that the SAM-associated left OA courses away from the greater curvature (white dotted circle), which means that this artery differs from left gastroepiploic artery. Note each tip of the triaxial catheter system consisting of the 4.2 Fr shepherd’s hook catheter (black arrowhead), the 2.8 Fr high-flow microcatheter (black curved arrowhead) and the 2.0 Fr microcatheter (black arrow). e DSA of the left OA in posteroanterior projection after embolization reveals complete hemostasis. Note that distal omental artery including the pseudoaneurysm (arrows) is densely embolized and that the distal normal left OA is also embolized with metallic coils (arrowhead)

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