EUS-guided Vascular Therapy

Visceral artery aneurysms are often asymptomatic and are incidental fi ndings on CT and MRI. Mortality from their rupture ranges from 25% to 100%.

Indications of treatment of true aneurysms include size >2 cm irrespective of anatomical site, symptomatic patients and increasing size of the aneurysm, size <2 cm in women who wish to become pregnant and patients who require liver transplant.

All false aneurysms should be treated, irrespective of their size or location.

Complications of endovascular treatment are technical failure to catheterize the artery, arterial thrombosis/embolism, coil migration, aneurysm recurrence, hematoma or pseudoaneurysm at the puncture site and abdominal pain, fever (post-embolization syndrome).

The role of endoscopic ultrasound (EUS) in vascular therapy is still evolving.

EUS-guided therapy has high technical and clinical success rates with no signifi cant adverse events. It is effective and less invasive than surgery/percutaneous options.

It is a day care procedure and does not require general anesthesia and can be done in conscious sedation. It permits precise targeting of aneurysm and precise injection. Less expensive than radiological treatment and can be repeated safely. A multicenter study is needed to further establish its role.

Despite technical success, there are limitations of a small number of enrolled subjects and poor methodology, varied procedural techniques and lack of large randomized controlled trials.

Indications should be clearly stated and patients carefully selected. Radiological and surgical back up is a must.