0:01

So let me show you this case,

0:03

and let's get your thoughts on this.

0:04

We have a 41-year-old male, incidental finding

0:07

of carotid artery aneurysm, pseudoaneurysm,

0:11

that was noted in a CT scan, and so the neuro IR

0:13

was called to perform a diagnostic angiogram.

0:16

So, what we see here is the following.

0:24

So, we see flow through a vessel,

0:28

a little pseudoaneurysm, with partial

0:32

thrombosis of the contained rupture sac.

0:35

So,

0:39

do you buy it?

0:41

Okay, I think maybe you do.

0:44

So what do you see?

0:45

So the patient developed a pseudoaneurysm

0:47

in the right common femoral artery, and so

0:50

it was measured at about three centimeters.

0:52

So what are you considering to do?

0:53

What's your decision tree in terms of management?

0:56

Well, let's maybe consider some

0:59

ultrasound-guided compression.

1:00

So in this case, 45 minutes of compression was

1:02

performed, body IR was consulted, and what happened?

1:07

It improved.

1:08

So, if percutaneous thrombin was considered,

1:13

do you think that's a reasonable sort of approach?

1:16

Well, I would say, you know, given the size of

1:19

the pseudoaneurysm, which is about two to three

1:21

centimeters, thrombin maybe shouldn't be injected.

1:26

And I would say it's not really the size of the

1:28

pseudoaneurysm necessarily, which is actually pretty

1:31

big, it's sort of the actual ratio of the neck.

1:35

And so thrombin was actually not injected. Ultrasound

1:38

was recommended as a compression therapeutic treatment

1:42

and follow-up ultrasound actually was performed

1:45

demonstrating that the thrombosis post-ultrasound

1:48

guided compression ended up being durable and the

1:50

patient did extremely well in the outpatient setting.