Transcatheter arterial embolization for gastroepiploic artery aneurysms: A single-center retrospective 12 case series

Background: Gastroepiploic artery aneurysms (GEAAs) and their rupture are very rare but often serious. However, emergency management has yet to be standardized. Purpose: To clarify the clinical features of GEAAs and outcomes of transcatheter arterial embolization (TAE). Materials and Methods: This is a retrospective, single-center 12 case series of GEAAs experienced between 2006 and 2023. We reviewed medical records to determine the case background, angiographic images, TAE techniques and success rate, and outcomes. Abdominal angiography was performed via the femoral artery to identify the inflow and outflow vessels of the GEAAs. Subsequently, a microcatheter was advanced to the target site, and embolization was performed with microcoils and/or NBCA-Lipiodol mixture. Results: Nine ruptured and one unruptured pseudo-GEAA cases were treated by emergency TAE, while the remaining two unruptured cases were treated electively. The average diameter of the ruptured GEAAs was 7.9 mm. The most common underlying diseases were segmental arterial mediolysis in 4 cases. Morphological classification revealed 5 cases of dissecting, 4 of pseudo, and 3 of true. TAE was successful in seven of the nine ruptured and in all three unruptured cases. Two patients with ruptured GEAAs after unsuccessful TAE were subsequently saved by surgery. TAE using the triple coaxial catheter system was performed in 7 cases with good results. Conclusions: Even small-diameter GEAAs can rupture, resulting in life-threatening conditions, but emergency TAE is safe and effective. However, there are some cases in which TAE fails, so it is important to make a prompt decision to proceed to surgical treatment.