Coil Embolization with Side-Holed Catheter to Preserve Peripheral Flow for Visceral Artery Pseudoaneurysm: An Experimental Study in Swine

Abstract Purpose To evaluate the safety and efficacy of coil embolization with an indwelling catheter with side holes to control visceral artery bleeding while simultaneously preserving peripheral artery flow. Materials and Methods A 6-F anticoagulant-coated catheter with two symmetrically arranged side holes was used with coil embolization to induce hemostasis in the superior mesenteric artery (SMA) of 13 pigs. The SMA was punctured with a metal needle to induce bleeding. The catheter was advanced into the SMA immediately after the puncture, and the midpoint between its tip and side holes was adjusted to conform to the puncture site. The SMA was embolized by using microcoils placed around the catheter to achieve hemostasis. Hemostasis and gross ischemic changes of the intestine were visually observed during the abdominal surgery. Peripheral blood flow was assessed by using abdominal aortography for as long as 2 hours in 13 pigs and was assessed again at 7 days in three pigs. Results Antegrade peripheral artery flow through the indwelling catheter was preserved without stagnation for as long as 2 hours in all 13 pigs and at 7 days in two of three pigs. One catheter occlusion was seen at the 7-day time point. There were no observable instances of recurrent bleeding, ischemic changes in the intestine, or vascular adverse events during or after the procedure. Conclusions The hemostatic method described here is a technically feasible method of controlling acute visceral artery bleeding while preserving peripheral artery flow and may be particularly useful in cases of absence of collateral circulation. Further experiments are warranted for clinical application.