1. A 53-year-old woman presented with acute abdominal pain and was found to have a retroperitoneal hematoma and intramesenteric bleeding from two aneurysms of the inferior pancreaticoduodenal artery. 2. The aneurysms were successfully treated via a transradial endovascular approach, with microcatheters used to deploy detachable coils to occlude the target vessels. 3. The transradial coil embolization demonstrated a minimally invasive treatment alternative to open surgery for this woman's spontaneous intramesenteric bleeding from inferior pancreaticoduodenal artery aneurysms.

1. AimRADIAL2017, 21-22.09.2017 Stuttgart, DE
Spontaneous intramesenteric
bleeding cured with transradial
coil implantation.
Misztal M., Krzywon J., Brzychczy A., Zbierska-Rubinkiewicz K.,
Grot A.,Trystula M.
Department ofVascular Surgery and Endovascular Interventions, John Paul II Hospital,
Krakow, Poland.

2. Disclosure :
I have no conflict of interest to
disclose

3. Clinical history :
 53 y woman
 Spontaneous, acute onset abdominal pain,
epigastrial pain location
 No history of abdominal trauma, heavy exercise,
high blood pressure
 Medical history:
- Chronic gastritis in the past
- Appendectomy in 1981
 Vegetarian
 Long history of smoking

4. Clinical history (2):
 Remote hospital admission:
- Hemodynamic stability on admission :
HR – 76/min, BP – 110/70 mmHg, Hgb – 13,9 g/dl, CRP – 8,9
mg/L
 Next day - pain worsening with hypovolemic shock
presentation
- Blood and plasma transfusion
CT abdominal scanning:
- Retroperitoneal hematoma of 700-800
ml volume
- Intramesenteric hematoma

5. Clinical history (3):
 Transfer to Vascular Surgery Department:
 ANGIO-CT abdominal scanning:
- Two fusiform aneurysms of inferior
pancreaticoduodenal artery (6 x 19 mm & 3 x
14 mm)

6. Challenge :
Coiling of the aneurysms as the optimal
treatment
 Probability of conversion to open
surgery during intervention
 Tortuosity of the splanchnic arteries
 Need for good
anchoring and stability
during coils deployment

7. Procedure :
 Left radial artery access – 5F
 Superior mesenteric artery
caniulation with hydrofilic guidewire
and Glidecath 5F catheter (Terumo,
Japan)
 Hi-Torque Supracore 35 Guide Wire
(Abbott Vascular, US) SMA anchoring
and exchange to Destination 90 cm/6F
sheath (Terumo, Japan)

8. Procedure (2):
 Caniulation of
inferior
pancreaticoduodenal
artery with V-14
ControlWire (BSC,
US) and Launcher JR
4,0/5F catheter
(Medtronic, US)
 Insertion of Rebar-18
microcatheter
(Medtronic, US) into
the target vessel

9. Procedure (3):
 Deployment of ConcertoTM
Detachable Coils
(Medtronic, US) : 5 mm/20 cm & 4 mm/8 cm
(2x)
 Complete occlusion of the target vessel
 Removal of the system

10. Conclusion :
 Transradial / endovascular
treatment should be the first strategy
in familiar anatomy splanchnic
arteries cases.
Our case is a perfect example of
minimal invasive treatment in
contrary to severe open abdomen
surgery.

11. Comments :
 Radial access seems to be safe
and useful way to treat
splanchnic artery abnormalities.
 Proper anchoring, good stability
should be assured to complete
procedure without problems.