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Kamada Y, Hori T, Yamamoto H, Harada H, Yamamoto M, Yamada M, Yazawa T, Sasaki B, Tani M, Sato A, Katsura H, Tani R, Aoyama R, Sasaki Y, Okada M, Zaima M. Fatal arterial hemorrhage after pancreaticoduodenectomy: How do we simultaneously accomplish complete hemostasis and hepatic arterial flow? World J Hepatol 2021; 13:483-503. [PMID: 33959229 PMCID: PMC8080554 DOI: 10.4254/wjh.v13.i4.483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/07/2021] [Accepted: 03/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although arterial hemorrhage after pancreaticoduodenectomy (PD) is not frequent, it is fatal. Arterial hemorrhage is caused by pseudoaneurysm rupture, and the gastroduodenal artery stump and hepatic artery (HA) are frequent culprit vessels. Diagnostic procedures and imaging modalities are associated with certain difficulties. Simultaneous accomplishment of complete hemostasis and HA flow preservation is difficult after PD. Although complete hemostasis may be obtained by endovascular treatment (EVT) or surgery, liver infarction caused by hepatic ischemia and/or liver abscesses caused by biliary ischemia may occur. We herein discuss therapeutic options for fatal arterial hemorrhage after PD.
AIM To present our data here along with a discussion of therapeutic strategies for fatal arterial hemorrhage after PD.
METHODS We retrospectively investigated 16 patients who developed arterial hemorrhage after PD. The patients’ clinical characteristics, diagnostic procedures, actual treatments [transcatheter arterial embolization (TAE), stent-graft placement, or surgery], clinical courses, and outcomes were evaluated.
RESULTS The frequency of arterial hemorrhage after PD was 5.5%. Pancreatic leakage was observed in 12 patients. The onset of hemorrhage occurred at a median of 18 d after PD. Sentinel bleeding was observed in five patients. The initial EVT procedures were stent-graft placement in seven patients, TAE in six patients, and combined therapy in two patients. The rate of technical success of the initial EVT was 75.0%, and additional EVTs were performed in four patients. Surgical approaches including arterioportal shunting were performed in eight patients. Liver infarction was observed in two patients after TAE. Two patients showed a poor outcome even after successful EVT. These four patients with poor clinical courses and outcomes had a poor clinical condition before EVT. Fourteen patients were successfully treated.
CONCLUSION Transcatheter placement of a covered stent may be useful for simultaneous accomplishment of complete hemostasis and HA flow preservation.
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Affiliation(s)
- Yasuyuki Kamada
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Hidekazu Yamamoto
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Hideki Harada
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Michihiro Yamamoto
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Masahiro Yamada
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Takefumi Yazawa
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Ben Sasaki
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Masaki Tani
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Asahi Sato
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Hikotaro Katsura
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Ryotaro Tani
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Ryuhei Aoyama
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Yudai Sasaki
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Masaharu Okada
- Department of Cardiovascular Medicine, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Masazumi Zaima
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
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Stepanenko AB, Charchyan ER, Gens AP, Fedorov DN, Ivanova AG, Vysotskiy MV, Belov YV. [Surgical treatment for fibro-muscular dysplasia]. Khirurgiia (Mosk) 2015:21-27. [PMID: 26762074 DOI: 10.17116/hirurgia2015921-27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM To present the results of surgical treatment of patients with fibro-muscular dysplasia. MATERIAL AND METHODS Our experience of treatment of 144 patients with fibro-muscular dysplasia is presented in the article. 118 (82%) patients suffered from stenoses, kinking and aneurysms of internal carotid arteries, 21 (14.5%) patients had lesion of renal arteries, 5 (3.5%) patients--azygous visceral arteries lesion. It was performed 157 reconstructive operations in the Department of cardiac surgery N(o)1 (aortic surgery) of acad. B.V. Petrovskiy Russian Research Center for Surgery for the period from 1993 to 2014. Clinical features of fibro-muscular dysplasia, surgical tactics and technique depending to the localization of lesion are described. RESULTS Immediate and remote surgical results were studied. There were no any severe intraoperative and immediate postoperative complications. Follow-up after carotid surgery was 104.49±68.68 months (6-247 months). Strokes were not observed. Hemodynamically insignificant re-stenoses were diagnosed in 7 (5.5%) cases. Mean follow-up after renal reconstructions was 139.24±63.96 months (28-239 months). Persistent blood pressure normalization was achieved in 11 (73.3%) cases. Patients with azygous visceral arteries dysplasia have been examined for the period of 103.4±69.6 months (35-205 months). There were no recurrent aneurysms and abdominal ischemia in the remote postoperative period. Hospital and remote mortality was absent. Based on own experience and colleagues' data we consider that surgical treatment of patients with some forms of fibro-muscular dysplasia provides satisfactory results if advisable strategy is selected.
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Affiliation(s)
- A B Stepanenko
- Acad. B.V. Petrovskiy Russian Research Center for Surgery, Moscow, Russia
| | - E R Charchyan
- Acad. B.V. Petrovskiy Russian Research Center for Surgery, Moscow, Russia
| | - A P Gens
- Acad. B.V. Petrovskiy Russian Research Center for Surgery, Moscow, Russia
| | - D N Fedorov
- Acad. B.V. Petrovskiy Russian Research Center for Surgery, Moscow, Russia
| | - A G Ivanova
- Acad. B.V. Petrovskiy Russian Research Center for Surgery, Moscow, Russia
| | - M V Vysotskiy
- Acad. B.V. Petrovskiy Russian Research Center for Surgery, Moscow, Russia
| | - Yu V Belov
- Acad. B.V. Petrovskiy Russian Research Center for Surgery, Moscow, Russia
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Endovascular treatment of superior mesenteric artery pseudoaneurysms using covered stents in six patients. AJR Am J Roentgenol 2014; 203:432-8. [PMID: 25055281 DOI: 10.2214/ajr.13.11644] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate our experience with the use of endovascular treatments for superior mesenteric artery (SMA) pseudoaneurysms using covered stents. MATERIALS AND METHODS Between 2002 and 2011, six patients (mean age, 41.7 years; range, 23-65 years) with SMA pseudoaneurysms were treated percutaneously with the placement of covered stents at our institution. The causes of SMA pseudoaneurysms were penetrating trauma (n = 2), blunt trauma (n = 1), and previous surgical procedures (n = 3). The mean diameter of the SMA pseudoaneurysms was 16 mm (range, 4-24 mm). Technical success and clinical success were retrospectively analyzed. RESULTS Immediate technical success, defined as exclusion of the pseudoaneurysm and lack of active extravasation, was achieved in all six patients. Secondary balloon angioplasty was needed in one patient with residual narrowing. There was a small dissection of the proximal SMA necessitating placement of a second bare stent across the dissection. A second covered stent (Fluency stent, 8 mm) was placed in the same patient because of recurrent bleeding due to a type II endoleak 5 days after the first covered stent had been placed. This patient had no subsequent episodes of bleeding or bowel ischemia. Follow-up CT in the remaining five patients (mean, 21 months; range, 1-58 months) confirmed stent patency and preserved distal arterial flow to the bowel without episodes of bleeding or bowel ischemia during follow-up (mean, 27 months; range, 11-58 months). CONCLUSION Percutaneous endovascular treatment using a covered stent may be a safe and feasible tool for SMA pseudoaneurysms.
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Xiao L, Shen J, Tong JJ. Emergency stent-graft implantation for iatrogenic peripheral arterial rupture. Radiol Med 2012; 118:152-7. [PMID: 22580807 DOI: 10.1007/s11547-012-0826-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 08/30/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE We evaluated the experience with and efficacy of stent-grafting for iatrogenic peripheral arterial ruptures. MATERIALS AND METHODS From 2005 to 2009 we performed stent-grafting on four male patients (age 38-67 years) with iatrogenic peripheral arterial ruptures. In patient 1, grointissue necrosis followed a subcutaneous injection and led to femoral arterial rupture. Pseudoaneurysms ruptured in patients 2 and 3 who were undergoing femoral arteriotomy. Patient 1 experienced a ruptured carotid artery during neck surgery. Shock occurred in three of the four patients. Four patients underwent self-expanding stent-grafting (8 mm×60 mm or 8 mm×80 mm) under local anaesthesia. RESULTS Haemorrhages were controlled in all patients. No procedure-related complications occurred. Patient 1 died of lung metastases 13 months after stent-grafting. Follow-up examinations showed that the stent-graft remained patent in patients 1, 2 and 4, whereas stent occlusion occurred after 15 months in patient 3; in this case, a pseudoaneurysm proximal to the stent was identified, and although repeat stent-grafting successfully stopped the bleeding, the patient died of multiple organ failure 1 week later. CONCLUSIONS Emergency stent-grafting is a technically feasible and therapeutically effective modality for treating high-risk patients who experience iatrogenic peripheral arterial ruptures. The efficient treatment of hypotension and early endovascular intervention will improve the prognosis.
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Affiliation(s)
- L Xiao
- Department of Radiology, the First Hospital of China Medical University, 155 Nanjing North Road, Shenyang 110001, Liaoning, PR China.
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Boufi M, Belmir H, Hartung O, Ramis O, Beyer L, Alimi YS. Emergency stent graft implantation for ruptured visceral artery pseudoaneurysm. J Vasc Surg 2011; 53:1625-31. [PMID: 21530142 DOI: 10.1016/j.jvs.2011.02.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Revised: 02/09/2011] [Accepted: 02/09/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND Literature series that include visceral artery pseudoaneurysms rarely separate them from true aneurysms, although they address different issues. Guidelines for optimal management of these lesions are lacking. We report our experience of stent graft treatment of these lesions with midterm results. METHODS We retrospectively reviewed all patients with a visceral pseudoaneurysm who were treated with a stent graft in our institution. Patient history, clinical characteristics, procedure details, and outcome were recorded and analyzed. RESULTS From March 2004 to June 2009, 10 consecutive patients (9 men), who were a mean age of 59 years, were treated for symptomatic visceral artery pseudoaneurysm, with hemorrhagic shock in 8 patients (80%), after pancreaticoduodenectomy in 8, gastrectomy in 1, and abdominal trauma in 1. A mean of 24 days (range, 7-60 days) passed between the initial surgery or trauma and pseudoaneurysm diagnosis. Septic complications were associated in six patients (60%). The pseudoaneurysm was in the hepatic artery in 8 patients, the splenic artery in 1, and the superior mesenteric artery in 1. Technical and clinical success was achieved in 80% of patients. Two failures of catheterization were followed by redo surgery and death (20%). No patients died postoperatively, and no complications among the patients who were treated successfully. Mean follow-up was 37 months (range, 10-63 months). All stent grafts were patent, with no signs of infection. Two patients died secondary to neoplasm. No rebleeding or recurrent aneurysms were noted. CONCLUSION Stent graft exclusion of visceral artery pseudoaneurysm seems to be a valid therapeutic approach regardless of the patient's septic or hemodynamic status.
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Affiliation(s)
- Mourad Boufi
- Department of Vascular Surgery, University Hospital Nord, Marseille, France.
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Au-Yong I, Watson NF, Boereboom CL, Bowling TE, Abercrombie JF, Whitaker SC. Endovascular treatment of a Superior Mesenteric Artery Syndrome variant secondary to traumatic pseudoaneurysm. World J Emerg Surg 2010; 5:7. [PMID: 20210994 PMCID: PMC2843665 DOI: 10.1186/1749-7922-5-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 03/08/2010] [Indexed: 11/13/2022] Open
Abstract
Pseudoaneurysms related to the superior mesenteric artery (SMA) are a recognised complication of trauma to the vessel, and successful treatment with stenting has been previously described. We report the case of a patient who presented with obstruction of the fourth part of the duodenum secondary to a traumatic pseudoaneurysm, a hitherto unreported variant of superior mesenteric artery syndrome. Exclusion of the pseudoaneurysm and relief of the duodenal obstruction were simultaneously achieved by placement of a covered stent.
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Affiliation(s)
- Iain Au-Yong
- Department of Surgery, Royal Derby Hospital, Uttoxeter Road, Derby, DN22 3NE, UK.
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Yeo KK, Dawson DL, Brooks JL, Laird JR. Percutaneous treatment of a large superior mesenteric artery pseudoaneurysm and arteriovenous fistula: A case report. J Vasc Surg 2008; 48:730-4. [DOI: 10.1016/j.jvs.2008.03.056] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 03/23/2008] [Accepted: 03/29/2008] [Indexed: 12/30/2022]
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Arat A, Turkbey B, Cil BE, Canyigit M, Cekirge S. Emergent treatment of an Iatrogenic arterial injury at femoral puncture site With Symbiot self-expanding PTFE-covered coronary stent-graft. ACTA ACUST UNITED AC 2008; 51 Suppl:B331-3. [PMID: 17991099 DOI: 10.1111/j.1440-1673.2007.01849.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report an intracranial stenting procedure complicated by active bleeding from the femoral puncture site because of high arterial puncture. The patient was treated by placement of two PTFE-covered self-expanding coronary stent-grafts. To our knowledge, there have been very few reports on stent-grafting of femoral artery in the literature. The low profile and flexibility of the coronary stent-graft enabled treatment via a six French sheath and 12th month patency is demonstrated with CT angiography.
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Affiliation(s)
- A Arat
- Department of Radiology, Baylor College of Medicine, Houston, USA
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9
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Editor’s Address. Cardiovasc Intervent Radiol 2007. [DOI: 10.1007/s00270-007-9216-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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10
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Wallace MJ, Choi E, McRae S, Madoff DC, Ahrar K, Pisters P. Superior mesenteric artery pseudoaneurysm following pancreaticoduodenectomy: management by endovascular stent-graft placement and transluminal thrombin injection. Cardiovasc Intervent Radiol 2007; 30:518-22. [PMID: 17031732 DOI: 10.1007/s00270-006-0109-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Superior mesenteric artery (SMA) pseudoaneurysm formation is a rare and potentially fatal postoperative complication. Herein we present a case of a large post-pancreaticoduodenectomy SMA pseudoaneurysm that required thrombin injection after initial stent-graft deployment to accomplish complete pseudoaneurysm occlusion.
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Affiliation(s)
- Michael J Wallace
- Department of Diagnostic Radiology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA.
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Bratby MJ, Lehmann ED, Bottomley J, Kessel DO, Nicholson AA, McPherson SJ, Morgan RA, Belli AM. Endovascular embolization of visceral artery aneurysms with ethylene-vinyl alcohol (Onyx): a case series. Cardiovasc Intervent Radiol 2007; 29:1125-8. [PMID: 16625409 DOI: 10.1007/s00270-005-0148-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
We report the application of the liquid embolic agent ethylene-vinyl alcohol (Onyx; MicroTherapeutics, Irvine, CA, USA) in the management of visceral artery aneurysms. The technique and indications for using Onyx are discussed with emphasis on the management of wide-necked aneurysms and maintenance of patency of the parent vessel. None of the cases was considered suitable for stent-grafting or embolization with conventional agents. Two aneurysms of the renal artery bifurcation and one aneurysm of the inferior pancreaticoduodenal artery were treated. Following treatment there was complete exclusion of all aneurysms. There was no evidence of end-organ infarction. Follow-up with intervals up to 6 months has shown sustained aneurysm exclusion. Onyx is known to be effective in the management of intracranial aneurysms. Our experience demonstrates the efficacy and applicability of the use of Onyx in the treatment of complex visceral artery aneurysms.
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Affiliation(s)
- M J Bratby
- Department of Radiology, St. George's Hospital, Ground Floor, St. James' Wing, Blackshaw Road, Tooting, London, SW17 0JT, UK
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Yan SL, Wu HS, Chou DA, Kuo CL, Huang HT, Lee YT, Huang MH. Pseudoaneurysm of Superior Mesentery Artery Branch After Renal Extracorporeal Shock Wave Lithotripsy: Case Report and Review. ACTA ACUST UNITED AC 2007; 62:770-3; discussion 773-4. [PMID: 17414365 DOI: 10.1097/01.ta.0000245036.68397.1d] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Sheng-Lei Yan
- Department of Internal Medicine, Division of Gastroenterology, Show-Chwan Memorial Hospital, Taiwan, Republic of China
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Miller MT, Comerota AJ, Disalle R, Kaufman A, Pigott JP. Endoluminal embolization and revascularization for complicated mesenteric pseudoaneurysms: A report of two cases and a literature review. J Vasc Surg 2007; 45:381-6. [PMID: 17264020 DOI: 10.1016/j.jvs.2006.09.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Accepted: 09/04/2006] [Indexed: 11/16/2022]
Abstract
Mesenteric artery pseudoaneurysms are a rare and complex complication after abdominal trauma, surgery, or inflammatory disease. These lesions can be associated with compression or erosion into adjacent structures and may result in life-threatening hemorrhage. Traditional management has been open surgical ligation, aneurysm resection with interposition grafts, or resection or partial resection of the end organ involved. We present two cases of endovascular repair of complex mesenteric pseudoaneurysms. One patient presented with a recurrent pseudoaneurysm of the superior mesenteric artery and the second presented as recurrent gastrointestinal bleeding secondary to a traumatic celiac artery pseudoaneurysm-to-pancreatic duct fistula. A systematic review of the literature on endovascular management of mesenteric vascular disease and mesenteric pseudoaneurysms is included in this report to allow these cases to be put into proper perspective.
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Kutlu R, Ara C, Sarac K. Bare Stent Implantation in Iatrogenic Dissecting Pseudoaneurysm of the Superior Mesenteric Artery. Cardiovasc Intervent Radiol 2006; 30:121-3. [PMID: 17086458 DOI: 10.1007/s00270-005-0392-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Iatrogenic arterial dissection leading to the development of dissecting pseudoaneurysms of the superior mesenteric artery (SMA) is a rare complication of angiography. Surgical and endovascular treatment options exist for this important condition. We report a case of bare stent implantation in dissecting pseudoaneurysm of the SMA that developed after angiography in a patient with acute mesenteric ischemia. Although it is rarely published, iatrogenic arterial dissection causing pseudoaneurysm can occur after diagnostic and interventional angiography. Bare stent implantation in dissecting pseudoaneurysm of the SMA could be an advantageous endovascular treatment option in selected cases due its to potential preservation of important side branches of the SMA.
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Affiliation(s)
- Ramazan Kutlu
- Department of Radiology, Inonu University School of Medicine, 44069 Malatya, Turkey.
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Ray B, Kuhan G, Johnson B, Nicholson AA, Ettles DF. Superior Mesenteric Artery Pseudoaneurysm Associated with Celiac Axis Occlusion Treated Using Endovascular Techniques. Cardiovasc Intervent Radiol 2006; 29:886-9. [PMID: 16652215 DOI: 10.1007/s00270-004-0113-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The case of a 30-year-old woman with a post-traumatic pseudoaneurysm of the superior mesenteric artery and associated celiac axis occlusion is presented. The patient was successfully treated with celiac artery recanalization and placement of a covered stent within the superior mesenteric artery. Follow-up at 3, 6, and 12 months and 3 years demonstrated patency of the covered stent and continued exclusion of the aneurysm. Although the long-term success of this procedure is unknown this management option should be considered where facilities are available, to reduce the increased morbidity associated with open surgical procedure.
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Affiliation(s)
- Biswajit Ray
- Department of Vascular Surgery, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK
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Harvey J, Dardik H, Impeduglia T, Woo D, DeBernardis F. Endovascular management of hepatic artery pseudoaneurysm hemorrhage complicating pancreaticoduodenectomy. J Vasc Surg 2006; 43:613-7. [PMID: 16520182 DOI: 10.1016/j.jvs.2005.11.031] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2005] [Accepted: 11/12/2005] [Indexed: 12/19/2022]
Abstract
Gastrointestinal bleeding is a morbid complication of pancreaticoduodenectomy. Determining its etiology is often a daunting challenge in that both common and unusual mechanisms may be operative. Visceral artery pseudoaneurysms, although rare, must be considered in that minimally invasive means are available for effective therapy. Our recent experience with two cases highlights the importance for both general and vascular surgeons to be aware of the diagnostic and therapeutic role for early angiography and deployment of endovascular techniques to achieve a successful outcome.
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Affiliation(s)
- John Harvey
- Vascular Surgery Service, Englewood Hospital and Medical Center, Englewood, NJ 07631, USA
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