Endoscopic ultrasound-guided vascular interventions: An expanding paradigm

Table 5 Published case series on endoscopic ultrasound-guided angiotherapy for arterial pseudoaneurysm

S.No.	Ref.	Cases	Age/sex	Chief complaints	Artery involved	PSA size (mm)	EUS needle used	Embolization agent used	EUS sessions needed	Technical/clinical success	Complications	Follow up and comments
1	Gamanagatti et al[91], 2015	3	56/M; 45/M; 30/M	Upper GI bleed (all 3)	GDA; Splenic; Splenic	-	22-G	Thrombin (500 IU, 300 IU, 400 IU)	1 each	Yes/yes	None	Imaging F/U: complete obliteration; no bleeding at 1 mo F/U
2	Jhajharia et al[92], 2018	3	43/M; 25/M; 55/M	Pain abdomen; hematemesis; Malena (respectively)	GDA; Right hepatic; splenic	40 × 50; 30 × 22 × 27; 15 × 13	22-G	Thrombin (1000 IU; 1000 IU; 500 IU)	1 each	Yes/yes	None	F/U at 1.5 years, 1 year and 3 mo: no bleeding (respectively)
3	Rai et al[93], 2018	6	Median 36.7 years (19-60); 5 men	3 asymptomatic; 3 upper GI bleed	All Splenic artery PSA	25-65 (range)	19-G	Coils (size 8, 14, 16; number 1-5) and glue (1-2 mL)	3 cases needed 2 EUS sessions (size > 4 cm)	Yes/yes (all cases)	None	EUS (4 wk) and CT (3 mo): complete obliteration
4	Maharshi et al[94], 2020	8	Median 34 years (27-58); all males	Malena (100%); hematemesis (75%)	Splenic (5); left hepatic (2); GDA (1)	Median 29 × 26 (range 18 × 19 – 40 × 50)	22-G	Thrombin (200-500 IU)	1	Yes/87.5% clinical success (7/8 cases)	2 cases post procedural pain	EUS (1 and 3 mo) and CT (1 mo): complete obliteration; only 1 case with PSA > 5 cm needed second EUS session after 6 wk
5	Samanta et al[95], 2022	16 PsA (in 15 patients)	Median 44 (17-56); males 14 (93.3%)	Malena/ incidental/ PCD bleed	Splenic (12); GDA (4)	Median 2.8 (0.9-9.7 cm)	19-G	Coils (median 1[1-8]) with CYA glue (median 2 [1-5 mL])	1 session in 15 (93.8%)	Yes/yes	One case had splenic infarct (managed conservatively)	Follow-up at 6 mo: no rebleed; one case developed recurrent PsA at a site separate from first PsA (managed again with EUS)

PsA: Pseuoaneurysm; EUS: Endoscopic ultrasound; F/U: Follow-up; IU: International units; GDA: Gastroduodenal artery; PCD: Percutaneous catheter drainage; CYA: Cyanoacrylate glue; GI: Gastrointestinal; CT: Computed tomography.