Endovascular treatment can be a fast and safe option in the case of acute, internal bleeding – but it requires special knowledge and technical skills. Interventionalists must consider the anatomy and potential complications. As in this case report, the anterior spinal artery, for example, can be a crucial vessel that must always be considered when embolizing intercostal or lumbar arteries. The risk of spinal ischemia has to be taken into account and should be minimized by choosing the appropriate treatment option. We report about a 77 year old, male patient with upper gastrointestinal bleeding after esophagectomy and gastric conduit reconstruction. A CT scan identified a pseudoaneurysm of an intercostal artery penetrating the gastric conduit as the bleeding source. In the DSA, a direct connection between the intercostal artery and the anterior spinal artery appeared to be likely. Due to the associated risk of spinal ischemia, an embolization of the intercostal artery was not an option. We decided to implant a stentgraft that would stop the perfusion of the pseudoaneurysm, but preserve the perfusion of the intercostal artery. Due to the small diameter of the vessel, we could not implant our commonly used stentgrafts in this case. Therefore, we chose an uncommon solution and used a stentgraft that is designed primarily for coronary arteries. Whenever intercostal or lumbar arteries need to be embolized, a possible connection to the anterior spinal artery must be considered and interventionalists have to be aware of possible ischemic complications. In this case, a stentgraft designed primarily for coronary arteries offered a good endovascular treatment option for the pseudoaneurysm of an intercostal artery. The risk of spinal ischemia could be minimized by using this stentgraft.

中文翻译：

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肋间动脉的假性动脉瘤：PK纸莎草冠状动脉支架的血管内治疗可预防脊柱缺血

在发生急性内部出血的情况下，血管内治疗可能是一种快速而安全的选择，但它需要特殊的知识和技术技能。介入医师必须考虑解剖结构和潜在的并发症。如在本病例报告中所示，例如，在栓塞肋间或腰动脉时，必须始终考虑前脊髓动脉，这是至关重要的血管。必须考虑脊柱缺血的风险，并应通过选择适当的治疗方案来将其降至最低。我们报道了约77岁的男性患者，在食管切除术和胃导管重建术后出现上消化道出血。CT扫描发现穿透胃导管的肋间动脉假性动脉瘤是出血源。在DSA中，肋间动脉和脊柱前动脉之间可能存在直接连接。由于伴有脊髓缺血的风险，因此不能选择栓塞肋间动脉。我们决定植入一种支架移植物，以停止假性动脉瘤的灌注，但保留肋间动脉的灌注。由于血管直径小，在这种情况下我们无法植入常用的支架植入物。因此，我们选择了一种不常见的解决方案，并使用了主要用于冠状动脉的支架移植物。每当需要栓塞肋间或腰动脉时，必须考虑可能与脊髓前动脉的连接，介入医师必须意识到可能的缺血性并发症。在这种情况下，主要为冠状动脉设计的覆膜支架为肋间动脉的假性动脉瘤提供了良好的血管内治疗选择。通过使用这种支架移植物，可以将脊髓缺血的风险降到最低。