This case represents a follow up of: Case 0598_11 -- Pseudoaneurysm in the right subclavian artery following stent-graft placement created by reversal of flow in the vertebral artery Case Reference No. CC-0798-01 This patient was restudied a few weeks after the stent-graft placement with an innominate arteriogram to verify the status of the pseudoaneurysm around the stent-graft in the right subclavian artery. The pseudoaneurysm was shown to persist with the right vertebral artery serving as an inflow and the right internal mammary artery forming the outflow of this lesion (as demonstrated in case 0598-11, Fig. 5). It was decided to eliminate this lesion by direct puncture and embolization. A 22G Chiba needle was used to access the pseudoaneurysm percutaneously. Through this needle an angiogram was performed (Fig. 1) which demonstrated continued patency of the pseudoaneurysm and fairly brisk flow into the right internal mammary artery. Ten Tornado microcoils (Cook, Bloomington In), 5-8 mm in diameter, were pushed through the Chiba needle into the pseudoaneurysm to obliterate it (Fig. 2). A repeat arteriogram (Fig. 3) demonstrated good patency through the reconstructed portion of the subclavian artery and complete obliteration and no filling of the pseudoaneurysm and its connecting vessels.   Questions: 1) How durable do you think this reconstruction is? 2) Any other materials for the embolization? 3) Any other route for the embolization?

Fig. 1. A 22G Chiba needle was introduced percutaneously into the pseudoaneurysm and angiogram performed. The peri stent-graft pseudoaneurysm fills with a brisk flow into the right internal mammary artery.   Fig. 2. Through the needle, 10 microcoils were pushed to fill and obliterate the pseudoaneurysm. Fig. 3. Repeat arteriogram demonstrates good patency through the reconstructed portion of the subclavian artery and complete obliteration and no filling of the pseudoaneurysm and its connecting vessels.