A middle aged male with Lymphoma had undergone CT guided retroperitoneal lymph node biopsy.
Subsequently, after 4 hours he started complaining of severe radiating pain.
A CT was done which showed a pseudoaneurysm from the lumbar artery wiht a large psoas hematoma.
Immediately the patient was taken up for DSA which showed the pseudoaneurysm from the right first lumbar artery branch.
This was embolised using nBCA-lipiodol mixture and microcoil.
Subsequently, the hematoma resolved.

Flow diverters are used for many purposes:
1. Giant aneurysms
2. Dissecting aneurysms
3. Blister aneuryms
4. Fusiform aneuryms
5. Wide neck aneurysms

While many cases have contrast stasis immediately after flow diverter placement, actual aneurysm 'closure' and arterial wall remodeling  and endothelialisation takes place after a variable time-frame.
We came across a case of subarachnoid hemorrhage, wherein DSA showed a irregular mild fusiform dilatation of the supraclinoid ICA with multiple blister like outpouchings.

Single PED Flex was placed, with no immediate change in appearance.
Patient developed vasospasm features, and was taken up for intra-arterial spasmolysis, during which the DSA showed smoothing of the arterial contour and non-visualisation of the blisters.

It can be said with guarantee that endothelialisation has not taken place, and the smoothening is due to the flow diversion effect. Probably the vasospasm also has added to the appearance.

DIAGNOSTIC DSA





FLOW DIVERTER



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