Clinical success was described as disappearance of symptoms in symptomatic cases or insignificant recanalization of the aneurysm treated with coil embolization and size decrement or occlusion of the aneurysmal sac
treated with flow diverters.
Digital subtraction angiography (DSA) showed a right STA pseudoaneurysm, with a previously positioned spring coil in the aneurysmal sac
In the case of AEF that is secondary to surgery, the most common cause is endoleak, or persistent bleeding, with a volumetric increase of the aneurysmal sac
, favored by dislocation or erosion of the aortic graft, or tissue degeneration resulting from fixation hooks or metallic stents.
Patient age, antero-posterior (AP) abdominal aortic diameter and longitudinal diameter (length) were quantitative variables while aneurysmal sac
form, wall calcification, involvement of renal artery and peri-aortic haematoma were qualitative variables.
Arterial ligation, excision of the aneurysmal sac
or arterial reconstruction (end to end or graft interposition) are the surgical treatment options.
The right ventricular side of the septum stayed intact and formed an aneurysmal sac
. The large pseudoaneurysm-like structure was indeed an intramural hematoma/dissection of the interventricular septum open only on the left ventricular side.
The occlusion of the left VA distal to the aneurysm was not performed because it would have required either to direct the catheter through the partially thrombosed aneurysmal sac
, with an unacceptable risk of distal embolism, or to navigate from the right VA to the vertebrobasilar junction and then downward through the left VA, which carried both technical difficulties and high risk of complications.
PTI was pioneered by Cope and Zeit in 1986  and since then has shown success in obliterating the aneurysmal sac
through thrombin injection and thrombus formation without the need to embolize inflow and outflow vessels.
Considering the increase in the aneurysmal sac
and absence of visible endoleak in CT, we proceed in DSA control for further investigation.
A large aneurysmal sac
triggers a strong local reaction around the aneurysm that provides high resistance to blood extravasation if AAA ruptures.
Thus the deformation transforms the curvature of the weakened portion of the blood vessel into an aneurysmal sac
and hence tolerating the extension of the membrane and transverse shear curving and pressure difference.
(5) Therapeutic strategies include surgical (revascularization, vessel ligature, aneurysmal sac
exclusion) or endovascular interventions (coil embolization, stent placement).