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Evans RPT, Mourad MM, Pall G, Fisher SG, Bramhall SR. Pancreatitis: Preventing catastrophic haemorrhage. World J Gastroenterol 2017; 23:5460-5468. [PMID: 28852306 PMCID: PMC5558110 DOI: 10.3748/wjg.v23.i30.5460] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/03/2017] [Accepted: 07/12/2017] [Indexed: 02/06/2023] Open
Abstract
Pancreatitis represents nearly 3% of acute admissions to general surgery in United Kingdom hospitals and has a mortality of around 1%-7% which increases to around 10%-18% in patients with severe pancreatitis. Patients at greatest risk were those identified to have infected pancreatic necrosis and/or organ failure. This review seeks to highlight the potential vascular complications associated with pancreatitis that despite being relatively uncommon are associated with mortality in the region of 34%-52%. We examine the current evidence base to determine the most appropriate method by which to image and treat pseudo-aneurysms that arise as the result of acute and chronic inflammation of pancreas. We identify how early recognition of the presence of a pseudo-aneurysm can facilitate expedited care in an expert centre of a complex pathology that may require angiographic, percutaneous, endoscopic or surgical intervention to prevent catastrophic haemorrhage.
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MESH Headings
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/etiology
- Aneurysm, False/therapy
- Angiography/methods
- Contrast Media/administration & dosage
- Embolization, Therapeutic/methods
- Endoscopy, Gastrointestinal
- Hemorrhage/diagnostic imaging
- Hemorrhage/etiology
- Hemorrhage/therapy
- Hospitalization/statistics & numerical data
- Humans
- Incidence
- Magnetic Resonance Imaging
- Necrosis
- Pancreas/blood supply
- Pancreas/pathology
- Pancreatectomy/adverse effects
- Pancreatectomy/methods
- Pancreatitis, Acute Necrotizing/complications
- Pancreatitis, Acute Necrotizing/epidemiology
- Pancreatitis, Acute Necrotizing/pathology
- Pancreatitis, Chronic/complications
- Pancreatitis, Chronic/diagnostic imaging
- Pancreatitis, Chronic/epidemiology
- Pancreatitis, Chronic/pathology
- Time Factors
- Tomography, X-Ray Computed/methods
- United Kingdom/epidemiology
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2
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Casey P, Kausar A, Gavan D, Wilde N. Ultrasound-guided percutaneous thrombin for the management of superior mesenteric artery pseudoaneurysm. J Vasc Surg Cases 2015; 1:211-213. [PMID: 31724605 PMCID: PMC6849914 DOI: 10.1016/j.jvsc.2015.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 06/24/2015] [Indexed: 11/23/2022] Open
Abstract
Visceral aneurysms are a well-recognized and potentially fatal occurrence in the event of rupture. Endovascular occlusion using stent grafting or embolization is often favorable over high-risk open surgical repair. However, interventional mesenteric angiography may not always be feasible or successful. We present an emergency case of successful occlusion of a large peripancreatic pseudoaneurysm using a single percutaneous injection of thrombin under ultrasound guidance alone after both laparotomy and mesenteric angiography had failed to identify and control bleeding. In this case and review of the current evidence, we propose an effective alternative first-line treatment strategy in these complex patients.
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Affiliation(s)
- Patrick Casey
- Department of Surgery, East Lancashire Hospital NHS Trusts, Blackburn, United Kingdom
| | - Ambareen Kausar
- Department of Surgery, East Lancashire Hospital NHS Trusts, Blackburn, United Kingdom
| | - Duncan Gavan
- Department of Radiology, East Lancashire Hospital NHS Trusts, Blackburn, United Kingdom
| | - Neil Wilde
- Department of Radiology, East Lancashire Hospital NHS Trusts, Blackburn, United Kingdom
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3
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Tuncel SA, Gülcü A, Yılmaz E, Çiftçi T, Göktay AY. Endovascular Stent-Graft Treatment of Giant Celiac Artery Pseudoaneurysm. Pol J Radiol 2015; 80:356-9. [PMID: 26236417 PMCID: PMC4505756 DOI: 10.12659/pjr.894377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/05/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Visceral artery aneurysms (VAAs) comprise an uncommon but life-threatening vascular disease. When rupture is the first clinical presentation, mortality rate reaches 70%. Increased use of cross-sectional imaging has led to a greater rate of diagnosis (40-80%) of asymptomatic VAAs. In the past, surgery was the treatment of choice for VAAs carrying high risk of mortality and morbidity. CASE REPORT A 22-year-old man, who had undergone gastric, pancreatic and aortic surgery 2.5 years earlier, presented with progressive abdominal pain. Multidetector computed tomography scan revealed an 8-cm celiac pseudoaneurysm. We report a giant celiac pseudoaneurysm treated with stent-graft implantation. CONCLUSIONS Endovascular treatment of VAA is a safe and effective method alternative to surgery.
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Affiliation(s)
| | - Aytaç Gülcü
- Department of Radiology, Dokuz Eylül University, İzmir, Turkey
| | - Erdem Yılmaz
- Department of Radiology, Trakya University, Edirne, Turkey
| | - Taner Çiftçi
- Department of Anesthesiology, Trakya University, Edirne, Turkey
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4
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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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Barbiero G, Battistel M, Susac A, Miotto D. Percutaneous thrombin embolization of a pancreatico-duodenal artery pseudoaneurysm after failing of the endovascular treatment. World J Radiol 2014; 6:629-635. [PMID: 25170402 PMCID: PMC4147445 DOI: 10.4329/wjr.v6.i8.629] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 05/24/2014] [Accepted: 06/18/2014] [Indexed: 02/07/2023] Open
Abstract
Pancreatico-duodenal artery (PDA) pseudoaneurysms are rare vascular conditions with high mortality rates after rupture and they are frequently secondary to pancreatitis, surgery, trauma or infection. Due to the high risk of rupture and bleeding, it is mandatory to treat all pseudoaneurysms, regardless of their size or symptomatology. First option of treatment is open surgical repair, but it has high mortality rate, especially in hemodynamically unstable patients. In the recent years, percutaneous ultrasonography (US)- or computed tomography-guided thrombin injection was proposed as an alternative method for treating visceral aneurysms and pseudoaneurysms, but few reports described this therapy in case of peri-pancreatic pseudoaneurysms. We present a rare case of pseudoaneurysm of the PDA in a patient with no previous history of pancreatitis nor major surgery but with an occlusive lesion of the celiac axis. To the best of our knowledge this is the first reported case of PDA pseudoaneurysm successfully treated in emergency by single transabdominal US-guided injection of thrombin after failed attempts of percutaneous catheterization of the feeding vessel of the pseudoaneurysm.
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6
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Teixeira PG, Thompson E, Wartman S, Woo K. Infective endocarditis associated superior mesenteric artery pseudoaneurysm. Ann Vasc Surg 2014; 28:1563.e1-5. [PMID: 24704049 DOI: 10.1016/j.avsg.2014.03.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 03/16/2014] [Accepted: 03/24/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since William Osler first described mycotic aneurysms in the setting of endocarditis in 1885, few pseudoaneurysms (PAs) of the superior mesenteric artery (SMA) have been reported in the literature. We report 2 cases of SMA PA related to infective endocarditis that were managed with open surgery. RESULTS Here we report 2 cases of SMA PAs treated with different surgical techniques. A 59-year-old male with a history of intravenous drug use presented with abdominal pain and was found to have Streptococcus viridans endocarditis and an SMA PA. A laparotomy was performed, and proximal and distal control of the SMA PA was obtained. After ensuring that Doppler signals were still present in the distal mesentery and the entirety of the bowel was viable, the SMA was ligated proximal and distal to the PA. The patient recovered uneventfully. The second case is a 35-year-old female who presented with abdominal pain and was found to have Streptococcos gordonii endocarditis and an SMA PA for which the patient was initially observed. After several weeks, the patient's condition deteriorated and the patient underwent open ligation of the SMA, proximal and distal to the PA, with a bypass from the infrarenal abdominal aorta to a distal unnamed SMA branch and resection of 3 ft of ischemic small bowel. The patient continued to have recurrent bowel ischemia over the next several weeks and ultimately died. CONCLUSIONS SMA PAs associated with infective endocarditis are rare, but carry a high risk of rupture and associated morbidity and mortality. Delay in surgical management may increase this risk.
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MESH Headings
- Adult
- Aneurysm, False/diagnosis
- Aneurysm, False/microbiology
- Aneurysm, False/surgery
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/surgery
- Endocarditis, Bacterial/complications
- Endocarditis, Bacterial/diagnosis
- Endocarditis, Bacterial/microbiology
- Fatal Outcome
- Female
- Humans
- Ligation
- Male
- Mesenteric Artery, Superior/diagnostic imaging
- Mesenteric Artery, Superior/microbiology
- Mesenteric Artery, Superior/surgery
- Mesenteric Ischemia/microbiology
- Middle Aged
- Streptococcal Infections/complications
- Streptococcal Infections/diagnosis
- Streptococcal Infections/microbiology
- Streptococcus gordonii/isolation & purification
- Substance Abuse, Intravenous/complications
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
- Vascular Grafting
- Viridans Streptococci/isolation & purification
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Affiliation(s)
- Pedro G Teixeira
- Division of Vascular Surgery and Endovascular Therapy, University of Southern California, Los Angeles, CA
| | - Eli Thompson
- Division of Vascular Surgery and Endovascular Therapy, University of Southern California, Los Angeles, CA
| | - Sarah Wartman
- Division of Vascular Surgery and Endovascular Therapy, University of Southern California, Los Angeles, CA
| | - Karen Woo
- Division of Vascular Surgery and Endovascular Therapy, University of Southern California, Los Angeles, CA.
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Papakostas JC, Theodoropoulos E, Karydas G, Chatzigakis PK. Contained rupture of a celiac artery aneurysm treated with aortic endograft deployment and assisting percutaneous coil and thrombin infusion. Vascular 2013; 21:183-8. [DOI: 10.1177/1708538113478735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this report we present a case of a ruptured celiac artery aneurysm (CAA) with a thrombosed distal neck, which was treated as an emergently with a deployment of a tube thoracic endograft to the descending thoracic and upper abdominal aorta. The initial treatment was assisted with a second stage percutaneous, transhepatic, ultrasound guided needle infusion of coil and thrombin to the aneurysmal sac due to type Ib endoleak, with immediate thrombosis of the aneurysm. This technique, although not standard, could also be considered as a useful choice for the treatment of CAAs with wide proximal and patent distal neck.
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Affiliation(s)
| | - Emmanouil Theodoropoulos
- Department of Interventional Radiology, ‘G. Gennimatas’ General Hospital of Athens, Athens, Greece
| | - George Karydas
- Department of Interventional Radiology, ‘G. Gennimatas’ General Hospital of Athens, Athens, Greece
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Oppenheimer J, Ray CE, Kondo KL. Miscellaneous pharmaceutical agents in interventional radiology. Semin Intervent Radiol 2012; 27:422-30. [PMID: 22550384 DOI: 10.1055/s-0030-1267854] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Interventional radiologists employ a wide variety of drugs on a daily basis to improve patient experiences and outcomes during interventional procedures. The expectation is for the interventionalist to be well-versed in all pharmaceuticals used in the interventional suite. In this article, the authors review the following classes of common miscellaneous pharmaceutical agents used in interventional radiology: vasodilators, vasoconstrictors, antiemetics, bowel antiperistalsis agents, and prothrombotics.
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Jiang J, Ding X, Su Q, Zhang G, Wang Q, Jian W, Wang Z, Hu S. Therapeutic management of superior mesenteric artery aneurysms. J Vasc Surg 2011; 53:1619-24. [PMID: 21531524 DOI: 10.1016/j.jvs.2011.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Revised: 01/14/2011] [Accepted: 02/02/2011] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Superior mesenteric artery (SMA) aneurysms are rare but life-threatening entities. This study summarizes our experience in providing therapeutic management for true aneurysms of the SMA. METHODS Between February 1998 and March 2010, 10 patients were diagnosed with true SMA aneurysms in our hospital. Medical data for demographics, clinical presentation, diagnosis, aneurysm characteristics, treatment modalities, outcomes, and follow-up were retrospectively analyzed. RESULTS Ten patients (six women, four men) were enrolled with a mean age of 56.7 years (range, 42-69 years). One patient (10%) had aneurysm rupture and presented with abdominal pain, and seven (70%) were asymptomatic. The size of nonruptured aneurysms ranged from 1.2 to 8.0 cm (mean, 3.5 cm). Of 10 patients, five received endovascular stent graft repair, two were treated surgically, two were observed, and one with aneurysm rupture died of hemorrhagic shock before surgery. The two surgical patients underwent SMA reconstruction after aneurysmectomy, and segmental bowel resection was performed in one patient after reconstruction. The overall mortality rate was 10%. Postoperative gastroparesis was identified in one patient (14.3%). Mean operation time was 3.6 hours in the surgical group and 1.3 hours in the endovascular group. Mean postoperative hospital stay for the two groups was 20.0 days and 2.2 days, respectively. Mean follow-up was 30.9 months (range, 3-72 months). Endoleak was found in one patient 3 months after endovascular repair. CONCLUSION True SMA aneurysms are uncommon entities with definite rupture risk and mortality. Compared with surgical intervention, endovascular stent graft placement is associated with less trauma and rapid recovery. It may be a promising alternative to surgical intervention. The most appropriate treatment depends on the characteristics of the lesion and the condition of the patient.
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Affiliation(s)
- Jianjun Jiang
- Department of Vascular Surgery, Qilu Hospital of Shandong University, Jinan, People's Republic of China
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10
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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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11
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Juszkat R, Krasiński Z, Wykrętowicz M, Staniszewski R, Majewski W. Transarterial thrombin injection secured with an embolic protection device as a treatment for a superior mesenteric artery pseudoaneurysm. Cardiovasc Intervent Radiol 2010; 34:198-201. [PMID: 20058004 DOI: 10.1007/s00270-009-9791-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Accepted: 12/08/2009] [Indexed: 12/17/2022]
Abstract
A pseudoaneurysm of the superior mesenteric artery (SMA) is a rare and life-threatening condition of various etiology. Even unruptured it can cause severe health problems or death. We report a 71-year-old male with a SMA pseudoaneurysm who was successfully treated with a transarterial thrombin injection secured with an embolic protection device used in carotid angioplasty. To our knowledge, this is the first case of a SMA pseudoaneurysm treated by this method.
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Affiliation(s)
- Robert Juszkat
- Department of Radiology, Poznań University of Medical Sciences, Szpital Kliniczny nr 1, Ul. Długa ½, 61-848, Poznan, Poland.
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Simultaneous Presentation of Coarctation of the Thoracic Aorta and Aneurysm of the Superior Mesenteric Artery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2009; 4:113-6. [DOI: 10.1097/imi.0b013e3181a39077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 34-year-old woman presented with both coarctation of the thoracic aorta and aneurysm of the superior mesenteric artery. The former was managed by open surgical repair, the latter by stent-graft. This case illustrates the need for facility with both percutaneous and open approaches to diseases of the aorta and its branches.
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13
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Karmy-Jones R, Bloch R, Martin MA. Simultaneous Presentation of Coarctation of the Thoracic Aorta and Aneurysm of the Superior Mesenteric Artery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2009. [DOI: 10.1177/155698450900400210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Riyad Karmy-Jones
- Heart and Vascular Institute, Southwest Washington Medical Center, Vancouver, WA, USA
| | - Robert Bloch
- Heart and Vascular Institute, Southwest Washington Medical Center, Vancouver, WA, USA
| | - M. Alan Martin
- Heart and Vascular Institute, Southwest Washington Medical Center, Vancouver, WA, USA
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14
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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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15
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Pasklinsky G, Gasparis AP, Labropoulos N, Pagan J, Tassiopoulos AK, Ferretti J, Ricotta JJ. Endovascular covered stenting for visceral artery pseudoaneurysm rupture: report of 2 cases and a summary of the disease process and treatment options. Vasc Endovascular Surg 2008; 42:601-6. [PMID: 18583306 DOI: 10.1177/1538574408318478] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present 2 cases of hemorrhage from a visceral artery pseudoaneurysm, managed successfully with endovascular covered stent placement. The first case was a 59-year-old man, 3 months after a laparoscopic distal pancreatectomy for adenoma, presenting with diffuse abdominal pain. The patient was evaluated with a computed tomography scan revealing a splenic artery pseudoaneurysm (PA) bleeding into a pancreatic pseudocyst. He was emergently taken to the angiography suite where a covered stent was deployed at the level of splenic artery PA. The second case was a 52-year-old woman with recurrent left retroperitoneal mass 5 years after distal pancreatectomy and splenectomy for a nonfunctional neuroendocrine tumor. She underwent resection of the mass in the left upper quadrant. Postoperative course was complicated by hematoma, abscess formation, reexploration, and repair of the duodenotomy and the portal vein. Subsequently, she was noted to have intermittent gastrointestinal hemorrhage, which prompted an angiogram revealing a hepatic artery PA that was repaired with a covered balloon-expandable stent. A completion angiogram was obtained in each case demonstrating exclusion of the PA. Our experience with these 2 cases supports the notion that endovascular covered stenting is a safe and effective therapy for exclusion of visceral artery aneurysm.
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Affiliation(s)
- Garri Pasklinsky
- Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, New York 11794-8191, USA
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16
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Marion-Audibert AM, Mesnil A, Guillet M, Rode A, Mabrut JY, Garbit V, Lepoutre-Dujardin E, Pere-Verge D, Baulieux J, Souquet JC. [Pseudoaneurysm of the hepatic artery: rare complication of chronic pancreatitis]. ACTA ACUST UNITED AC 2008; 32:74-8. [PMID: 18405652 DOI: 10.1016/j.gcb.2007.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Bleeding from a pseudoaneurysm is a rare complication of chronic pancreatitis. We present two cases of ruptured pseudoaneurysms of the hepatic arteries. The first case involved a pancreatic pseudocyst that ruptured in the duodenum and the second resulted in an intrahepatic hematoma that compressed the bile tract causing secondary hemobilia. Angiographic embolization was the primary treatment in both cases, with surgery for the first patient and later radiological drainage in the second. The hemorrhage was controlled in both cases despite the severe prognosis and high mortality in these cases.
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Affiliation(s)
- A-M Marion-Audibert
- Service d'hepatogastroenterologie, hôpital de la Croix-Rousse, 103, Grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
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