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. 2021 Feb 28;15(2):25–34. doi: 10.3941/jrcr.v15i2.3901

Figure 6.

Figure 6

74-year-old male with acalculous hemorrhagic cholecystitis complicated by massive hemoperitoneum.

FINDINGS: A) Digital subtraction angiography (DSA) showed a replaced right hepatic artery from the superior mesenteric artery. The cystic artery arising from the replaced right hepatic artery later demonstrates irregularity (black arrow) with an actively bleeding pseudoaneurysm. B) Extravasated contrast delineates the contour of the medial border of the gallbladder (red arrow). C) Post-embolization images demonstrate occlusion of the cystic artery with microcoils (white arrow), and subsequent cessation of the extravasation.

TECHNIQUE: SMA angiography with sub-selective catheterization of the cystic artery arising off a replaced right hepatic artery was performed, followed by microcoil embolization of an actively bleeding cystic artery pseudoaneurysm. Embolization material: Polyvinyl alcohol (PVA) particles (500–700 microns) (Contour; Boston Scientific, Natick, MA) followed by seven 3 x 30 mm and 4 x 30 mm microcoils (VortX microcoils; Boston Scientific, Natick, MA). Contrast: 168 mL Omnipaque-240. Fluoroscopy time: 36.2 minutes. Cumulative dose: 1303 mGy. Dose Area Product: 33623 mGym2.