Patient guide
Aneurysm and pseudoaneurysm treatment without open surgery: coils, glue and stent grafts
How visceral artery aneurysms, iliac aneurysms and pseudoaneurysms are treated with coil embolization, glue (NBCA), plugs and covered stents, who needs treatment, risks and follow-up.
Endovascular aneurysm treatment at a glance
- No open surgeryThrough a wrist or groin puncture
- Short stayOften 1 to 3 days
- TargetedOnly the aneurysm is closed
- Artery can be keptWith a covered stent
- Quick recoveryCompared with open repair
- Follow-up imagingTo confirm it stays closed
Which aneurysms this covers
This guide is about aneurysms outside the main aorta (for aortic aneurysms see the EVAR and TEVAR guide). Visceral artery aneurysms arise in the arteries to the spleen, kidney, liver, bowel and pancreas, and are often found by chance on a scan. Iliac artery aneurysms lie in the pelvis. A pseudoaneurysm is a contained leak from an artery, caused by injury, a biopsy, surgery or inflammation such as pancreatitis, and is more likely to rupture than a true aneurysm.
Who needs treatment
Many small aneurysms without symptoms can be watched. Treatment is advised for aneurysms that are growing, large, symptomatic or have ruptured, for pseudoaneurysms, and in women who are pregnant or planning pregnancy when the aneurysm is in a risky place, such as the splenic artery. The Society for Vascular Surgery guideline sets size and risk thresholds for each artery and notes that endovascular treatment is the usual approach when the anatomy allows [1]. Your own scan guides the decision.
Coils, glue and stent grafts compared
The aim is the same, to seal the aneurysm from the circulation, but the tools differ.
| Coils | Glue (NBCA) | Covered stent (stent graft) | |
|---|---|---|---|
| How it works | Soft metal coils packed in the sac or the artery to cause clotting | A liquid glue injected through a catheter that sets inside the vessel | A fabric-covered stent lining the artery and sealing the hole |
| Best for | Aneurysms with a narrow neck, and arteries that can be sacrificed | Hard-to-reach branches and as an addition to coils | Aneurysms in arteries that must stay open |
| Artery stays open? | Sometimes, with a sac-only approach | Usually not | Yes |
| Main concern | Coil movement or sac refilling | Glue reaching a wrong artery | Needs a straight, suitable artery and blood thinners afterwards |
How the procedure is done
Procedures usually take 1 to 2 hours.
- A CT angiogram plans the approach and measures the artery and the neck of the aneurysm.
- Under local anaesthetic, a catheter enters an artery in the wrist or groin and is guided to the aneurysm under X-ray.
- The sac or the feeding artery is filled with coils or glue, or a covered stent is placed across the opening.
- A final X-ray confirms that blood no longer enters the aneurysm.
- Most people stay one to three days. A follow-up scan checks that it stays closed.
Pseudoaneurysms and bleeding arteries
A pseudoaneurysm after a groin puncture can sometimes be closed by an ultrasound-guided injection of clotting medicine (thrombin) into the sac. Deeper pseudoaneurysms, and those causing bleeding after surgery, pancreatitis or injury, are usually treated by coil or glue embolization of the source artery or a covered stent, which can be life saving in an emergency.
Risks and follow-up
Risks include damage to the access artery, closing off a healthy branch that supplies an organ (for example a small area of spleen or kidney infarction), coil or glue moving, the sac refilling over time, and, after covered stents, blockage. After embolization some people have pain, fever or nausea for a few days (post-embolization syndrome). Repeat imaging at set intervals checks that the aneurysm has stayed closed [1].
Cost and insurance
Health insurance can cover these procedures, subject to your policy terms. The cost depends on the hospital, the devices used and the length of stay, and is explained once the plan is made after consultation and a review of your scans. Cashless treatment can be arranged with major Indian health insurers and TPAs, and credit treatment is available for CGHS and Singareni beneficiaries. Eligibility is confirmed after a policy check.
Frequently asked questions
- Does every aneurysm need to be treated?
- No. Small, symptom-free aneurysms are often watched with scans. Treatment is advised for growth, large size, symptoms, rupture or pseudoaneurysm [1].
- What is a pseudoaneurysm?
- A false aneurysm, in which blood leaks from an artery but is held in by surrounding tissue. It can rupture and usually needs treatment.
- When is glue used instead of coils?
- Glue is used for small or hard-to-reach branches, or with coils to seal a vessel, when the artery does not need to remain open.
- Can the artery stay open after treatment?
- Yes, if a covered stent is used or the sac alone is filled. When the artery itself is blocked, the organ usually gets blood from other vessels.
- Is surgery still needed sometimes?
- Yes, for aneurysms with unsuitable anatomy or when endovascular treatment fails. Your doctors decide this together [1].
References
- Chaer RA, Abularrage CJ, Coleman DM, et al. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg. 2020;72(1S):3S-39S. Read the source
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