1
|
Yoshikawa C, Yamato I, Nakata Y, Nakagawa T, Inoue T, Nakatani M, Nezu D, Doi S, Kuroda Y, Fujii K, Kishida S, Kamikubo M, Ko S. Giant splenic artery aneurysm rupture into the stomach that was successfully managed with emergency distal pancreatectomy. Surg Case Rep 2022; 8:148. [PMID: 35915344 PMCID: PMC9343537 DOI: 10.1186/s40792-022-01498-3] [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: 07/17/2021] [Accepted: 07/16/2022] [Indexed: 11/21/2022] Open
Abstract
Background Splenic artery aneurysms usually rupture into the free peritoneal space and rarely into the gastrointestinal tract. We report the case of a patient with a giant splenic artery aneurysm that ruptured in to the stomach with hemorrhagic shock and was successfully treated with emergency surgery. Case presentation A 59-year-old man presented to the emergency department with chest pain and syncope. Contrast-enhanced computed tomography showed splenic artery aneurysm with active contrast extravasation. He developed upper gastrointestinal (UGI) bleeding and hypovolemic shock. We diagnosed a splenic artery aneurysm ruptured in to the stomach, performed emergency distal splenopancreatectomy including the aneurysm and partial gastric resection, and could prevent patient death. Conclusions This report shows that splenic artery aneurysm can cause UGI bleeding. Thus, clinicians should be alert about this condition when managing patients with UGI bleeding and/or splenic artery aneurysm.
Collapse
|
2
|
Okumura T, Kimura T, Nakajima D, Kondo S, Kako S, Takahashi Y, Yamaka K, Ichinohe F, Tsukahara Y, Nagaya T, Umemura T. Splenic artery pseudoaneurysm resulting from gastric ulcer presenting acute upper gastrointestinal bleeding. Radiol Case Rep 2022; 18:97-99. [PMID: 36324839 PMCID: PMC9619333 DOI: 10.1016/j.radcr.2022.09.105] [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: 09/21/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
Splenic artery pseudoaneurysm (SAP) is a rare entity, which occurs when the arterial wall is composed only of the intima and media mainly caused by pancreatitis, or abdominal trauma. Regardless of size, SAP is a high mortality disease that carries a high risk of rupture, causing abdominal pain and severe pancreatic and gastrointestinal bleeding. Here, we describe a rare case of SAP rupture caused by a large gastric ulcer due to Helicobacter pylori infection and NSAIDs use. Understanding the characteristic enhanced CT images of SAP, the complications of splenic infarction, and the therapeutic efficacy of arterial embolization is essential for the clinician to properly diagnose and treat SAP.
Collapse
Affiliation(s)
- Taiki Okumura
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takefumi Kimura
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
- Consultation Center for Liver Diseases, Shinshu University Hospital, Matsumoto, Japan
- Corresponding author
| | - Daichi Nakajima
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shohei Kondo
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Satoko Kako
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiyuki Takahashi
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kosuke Yamaka
- Division of Nephrology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Fumihito Ichinohe
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshinori Tsukahara
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tadanobu Nagaya
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takeji Umemura
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
- Consultation Center for Liver Diseases, Shinshu University Hospital, Matsumoto, Japan
| |
Collapse
|
3
|
Carriero S, Lanza C, Biondetti P, Renzulli M, Bonelli C, Piacentino F, Fontana F, Venturini M, Carrafiello G, Ierardi AM. Imaging-Guided Percutaneous Puncture and Embolization of Visceral Pseudoaneurysms: Feasibility and Outcomes. J Clin Med 2022; 11:jcm11112952. [PMID: 35683341 PMCID: PMC9181803 DOI: 10.3390/jcm11112952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 02/01/2023] Open
Abstract
Visceral artery pseudoaneurysms (VAPAs) are the most frequently diagnosed pseudoaneurysms (PSAs). PSAs can be asymptomatic or symptomatic. The aim of our study was to evaluate the safety and effectiveness of percutaneous embolization of VAPAs performed on patients with an unfeasible trans-arterial approach. Fifteen patients with fifteen visceral PSAs, with a median dimension of 21 mm (IQR 20–24 mm), were retrospectively analyzed. No patients were suitable for trans-arterial catheterization and therefore a percutaneous approach was chosen. During percutaneous treatments, two embolic agents were used, either N-butyl cyanoacrylate (NBCA) (Glubran II, GEM Milan, Italy) mixed with Lipiodol (Lipiodol, Guerbet, France) or thrombin. The outcomes of this study were technical success, primary clinical success, and secondary clinical success. In our population the 15 PSA were located as follows: 2 in the left gastric artery, 1 in the right gastric artery, 3 in the right hepatic artery, 2 in a jejunal artery, 1 in left colic artery branch, 1 in a right colic artery branch, 1 in the gastroepiploic artery, 1 in the dorsal pancreatic artery, 1 in an ileocolic artery branch, 1 in an iliac artery branch, and 1 in a sigmoid artery branch. 80% of PSAs (12/15) were treated with a NBCA:lipiodol mixture and 20% of PSAs (3/15) were treated with thrombin. Technical, primary, and secondary clinical successes were obtained in 100% of the cases. No harmful or life-threatening complications were observed. Minor complications were registered in 26.6% (4/15) of the patients. Percutaneous embolization of visceral PSA is a safe and effective treatment and should be considered as an option when the endovascular approach is unsuccessful or unfeasible.
Collapse
Affiliation(s)
- Serena Carriero
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy;
| | - Carolina Lanza
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy;
- Correspondence:
| | - Pierpaolo Biondetti
- Interventional Radiology Unit, Department of Radiology, Foundation IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; (P.B.); (G.C.); (A.M.I.)
- Department of Health Science, Università degli Studi di Milano, 20122 Milan, Italy
| | - Matteo Renzulli
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant’Orsola Hospital, University of Bologna, 40138 Bologna, Italy;
| | - Cristian Bonelli
- Healthcare Professional Department, Foundation IRCSS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy; (F.P.); (F.F.); (M.V.)
- Department of Radiology, Insubria University, 21100 Varese, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy; (F.P.); (F.F.); (M.V.)
- Department of Radiology, Insubria University, 21100 Varese, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy; (F.P.); (F.F.); (M.V.)
- Department of Radiology, Insubria University, 21100 Varese, Italy
| | - Gianpaolo Carrafiello
- Interventional Radiology Unit, Department of Radiology, Foundation IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; (P.B.); (G.C.); (A.M.I.)
- Department of Health Science, Università degli Studi di Milano, 20122 Milan, Italy
| | - Anna Maria Ierardi
- Interventional Radiology Unit, Department of Radiology, Foundation IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; (P.B.); (G.C.); (A.M.I.)
| |
Collapse
|
4
|
Tsai YC, Tseng HS, Lee EW, Lee RC, Chiu NC, Hwang HE, Liu CA. Percutaneous direct puncture and embolization of vascularly inaccessible abdominal visceral pseudoaneurysms: A single-center experience and literature review. J Chin Med Assoc 2022; 85:240-245. [PMID: 34882098 DOI: 10.1097/jcma.0000000000000679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To evaluate the techniques, efficacy, and safety for treating vascularly inaccessible abdominal visceral pseudoaneurysms by direct puncture and embolization. METHODS A retrospective study of 5 consecutive patients who underwent percutaneous direct puncture embolization for intra-abdominal pseudoaneurysms in our institution between January 2009 and December 2016. Technical aspects, success, clinical outcome, and complications were discussed. RESULTS Four patients (80%) were men, and the mean age of all five patients was 57.2 years (range, 47-72 years). The mean diameter of the pseudoaneurysms was 2.5 cm (range, 1.9-3.4 cm). All the pseudoaneurysms were punctured under the imaging guidance of fluoroscopy, ultrasound, or computed tomography. Coils and glue were used in four of the patients, the remaining one with coil only. The mean injected glue volume was 1.5 (range, 0.8-2) mL. The overall technical and clinical success rate was 100% without major complications or mortality. CONCLUSION Our single-center experience and the literature review demonstrate that percutaneous direct puncture embolization is feasible and effective to serve as an alternative for treating abdominal vascular pseudoaneurysms when the traditional endovascular embolization fails. In this approach, fluoroscopy is the most needed guidance technique.
Collapse
Affiliation(s)
- Yin-Chen Tsai
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsiou-Shan Tseng
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Imaging, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
| | - Edward W Lee
- Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, Ronald Reagan Medical Center at UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Rheun-Chuan Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Nai-Chi Chiu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsuen-En Hwang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chien-An Liu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
5
|
Kumar SK, Singh JR, Kumar M, Nagbhushan K, Reddy ND, Rao G. Direct Percutaneous Puncture and Embolization of Visceral Pseudoaneurysm: Safety and Clinical Efficacy. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2020. [DOI: 10.1055/s-0040-1721529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Abstract
Purpose The aim of the study is to assess the safety and clinical effectiveness of direct percutaneous embolization of visceral artery pseudoaneurysms.
Materials and Methods Retrospective analysis of patients who had undergone direct percutaneous embolization of visceral artery pseudoaneurysms between January 2012 and May 2017 was performed. The study included 26 patients with a mean age of 36 years (range 10–71 years). The indications for direct percutaneous embolization included the inability to catheterize endovascularly (n = 24) or prior embolization (n = 2) of the feeding artery. Patient demographics, details of the procedure, complications, and outcomes were evaluated. Patients were followed for a mean of 15 months to assess for recurrence of the pseudoaneurysms on ultrasound.
Results Splenic artery (n = 13), gastroduodenal artery (n = 4), right hepatic artery (n = 3), pancreaticoduodenal arteries (n = 3), left gastric artery (n = 2), and left hepatic artery (n = 1) were the embolized arteries. Etiology for pseudoaneurysm were pancreatitis (n = 20), trauma (n = 2), postoperative (n = 2), and few were incidentally detected (n = 2). N-butyl cyanoacrylate (NBCA) with lipiodol was used in 23 (88.4%) patients, coil in one (3.8%), and both coil and NBCA in two patients (7.7%). Embolization of the pseudoaneurysm was successful in all cases. No procedure-related complication was observed. Follow-up showed no recurrence of the pseudoaneurysm. Self-limiting splenic infarct was seen in six patients. Self-limiting abdominal pain was seen in all the patients with embolization with NBCA. One patient developed liver infarct and subsequent liver abscess requiring percutaneous drainage.
Conclusion Direct percutaneous embolization is safe and effective in the treatment of visceral artery pseudoaneurysms and should be considered as an alternative in patients with a failed endovascular approach.
Collapse
Affiliation(s)
- Sunil K. Kumar
- Department of Interventional Radiology, Asian Institute of Gastroenterology, Davanagere, Hyderabad, Telangana, India
| | - Jagadeesh R. Singh
- Department of Interventional Radiology, Asian Institute of Gastroenterology, Davanagere, Hyderabad, Telangana, India
| | - Mahesh Kumar
- Department of Interventional Radiology, Asian Institute of Gastroenterology, Davanagere, Hyderabad, Telangana, India
| | - K.N. Nagbhushan
- Department of Interventional Radiology, Asian Institute of Gastroenterology, Davanagere, Hyderabad, Telangana, India
| | - Nageshwar D. Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - G.V. Rao
- Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| |
Collapse
|
6
|
Mohan SC, Srinivasan S, Paul SPL, Chung R, Natarajan SK. Hemosuccus pancreatitis due to a ruptured splenic artery pseudoaneurysm - diagnosis and endovascular management. J Radiol Case Rep 2020; 14:7-15. [PMID: 33082922 DOI: 10.3941/jrcr.v14i5.3938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Hemosuccus pancreatitis is a rare and potentially fatal cause of upper gastrointestinal bleeding characterized by hemorrhage from the ampulla of Vater via the pancreatic duct. In this case, a patient with chronic pancreatitis on a background of chronic alcoholism is found to have a splenic artery pseudoaneurysm that was bleeding into the pancreatic duct. This was identified on contrast-enhanced computed tomography imaging and successfully managed via microcoil embolization.
Collapse
Affiliation(s)
| | | | - See Poh Lye Paul
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Raymond Chung
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore, Singapore
| | | |
Collapse
|
7
|
Maharshi S, Sharma SS, Sharma D, Sapra B, Nijhawan S. Response to letter on endoscopic ultrasound-guided thrombin injection a management approach for visceral artery pseudoaneurysm: case series. Endosc Int Open 2020; 8:E968. [PMID: 32633730 PMCID: PMC7326579 DOI: 10.1055/a-1178-9630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Affiliation(s)
- Sudhir Maharshi
- Department of Gastroenterology, SMS Medical College and Hospitals, Jaipur, India
| | - Shyam Sunder Sharma
- Department of Gastroenterology, SMS Medical College and Hospitals, Jaipur, India
| | - Deepak Sharma
- Department of Gastroenterology, SMS Medical College and Hospitals, Jaipur, India
| | - Bharat Sapra
- Department of Gastroenterology, SMS Medical College and Hospitals, Jaipur, India
| | - Sandeep Nijhawan
- Department of Gastroenterology, SMS Medical College and Hospitals, Jaipur, India
| |
Collapse
|
8
|
Jhajharia A, Wanjari S, Ashdhir P, Sharma D, Pokharna R, Nijhawan S. Endoscopic ultrasound-guided thrombin injection for management of visceral artery pseudoaneurysm: A novel approach. Indian J Gastroenterol 2018; 37:271-275. [PMID: 29971689 DOI: 10.1007/s12664-018-0865-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 05/28/2018] [Indexed: 02/04/2023]
Abstract
Visceral artery pseudoaneurysm is a rare and potentially life-threatening vascular entity with a high mortality rate, conventionally managed with digital subtraction angiography with coil embolization or surgery. However, in cases where angiographic coil embolization is not possible due to technical reasons, computerized tomography (CT)/ultrasonography-guided thrombin injection remains a viable option as described in the literature. In this case series, we intend to highlight the role of endoscopic ultrasound-guided thrombin injection in the management of abdominal visceral artery pseudoaneurysm, which is either inaccessible by endovascular route or have high surgical risk of complication.
Collapse
Affiliation(s)
- Ashok Jhajharia
- Department of Gastroenterology, SMS Medical College and Hospital, House No. 109, Shiv Vihar Infront of Road No 5, VKI Sikar Road, Jaipur, 302 004, India.
| | - Shashank Wanjari
- Department of Gastroenterology, SMS Medical College and Hospital, House No. 109, Shiv Vihar Infront of Road No 5, VKI Sikar Road, Jaipur, 302 004, India
| | - Prachis Ashdhir
- Department of Gastroenterology, SMS Medical College and Hospital, House No. 109, Shiv Vihar Infront of Road No 5, VKI Sikar Road, Jaipur, 302 004, India
| | - Deepak Sharma
- Department of Gastroenterology, SMS Medical College and Hospital, House No. 109, Shiv Vihar Infront of Road No 5, VKI Sikar Road, Jaipur, 302 004, India
| | - Rupesh Pokharna
- Department of Gastroenterology, SMS Medical College and Hospital, House No. 109, Shiv Vihar Infront of Road No 5, VKI Sikar Road, Jaipur, 302 004, India
| | - Sandeep Nijhawan
- Department of Gastroenterology, SMS Medical College and Hospital, House No. 109, Shiv Vihar Infront of Road No 5, VKI Sikar Road, Jaipur, 302 004, India
| |
Collapse
|
9
|
Shrivastava A, Rampal JS, Reddy DN, Rao GV. Direct Needle Puncture and Embolization of Splenic Artery Pseudoaneurysm in Case of Chronic Atrophic Calcific Pancreatitis. Pol J Radiol 2016; 81:462-464. [PMID: 27757174 PMCID: PMC5040223 DOI: 10.12659/pjr.898000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/13/2016] [Indexed: 12/14/2022] Open
Abstract
Background Gastro-Intestinal bleeding remains a frequent clinical dilemma and common cause of hospitalization, morbidity and mortality. Case Report We report a case of pseudo aneurysm of splenic artery developed after an episode of acute on chronic pancreatitis which was treated by direct percutaneous puncture of pseudoaneurysm and embolization by coils. Conclusions The aim was to preserve the main splenic artery and avoid the complications of splenic artery embolization like infarcts and abscess.
Collapse
Affiliation(s)
- Amit Shrivastava
- Department of Radiology, Mahatma Gandhi Medical College, Jaipur, India
| | - Jagadeesh Singh Rampal
- Department of Intervention Radiology, Asian institute of Gastroenterology, Hyderabad, India
| | - D Nageshwar Reddy
- Department of Medical Gastroenterology, Asian institute of Gastroenterology, Hyderabad, India
| | - Guduru Venkat Rao
- Department of Medical Gastroenterology, Asian institute of Gastroenterology, Hyderabad, India
| |
Collapse
|
10
|
Kickuth R, Hoppe H, Saar B, Inderbitzin D, Triller J, Raessler S, Gschossmann J. Superselective transcatheter arterial embolization in patients with acute peripancreatic bleeding complications: review of 44 cases. Abdom Radiol (NY) 2016; 41:1782-92. [PMID: 27188888 DOI: 10.1007/s00261-016-0772-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate the efficacy of superselective transcatheter arterial embolization (TAE) in the treatment of acute peripancreatic bleeding complications. METHODS During a 9-year period, 44 patients with acute bleeding of the peripancreatic arteries underwent TAE in our institution. Thirty-eight patients were treated using microcatheters and 6 patients with a diagnostic catheter. Embolic agents included coils (n = 38), polyvinyl alcohol (PVA) particles (n = 2), isobutyl cyanoacrylate (n = 2), coils plus PVA particles (n = 1), and coils plus isobutyl cyanoacrylate (n = 1). Outcome measures included technical success, clinical success, and the rate of complications. RESULTS Identified bleeding sources included gastroduodenal artery (n = 14), splenic artery (n = 9), pancreaticoduodenal artery (n = 6), common hepatic artery (n = 5), superior mesenteric artery branches (n = 4), proper hepatic artery (n = 3), and dorsal/transverse pancreatic artery (n = 3). Technical success with effective control of active bleeding was achieved in 41/44 patients (93 %). Clinical success attributed to TAE alone was documented in 40/44 patients (91 %). The rate of major complications was 2 % including death in one patient. CONCLUSIONS Superselective TAE allows effective, minimally invasive control of acute peripancreatic bleeding complications with a low rate of therapeutically relevant complications.
Collapse
|
11
|
Sawicki M, Marlicz W, Czapla N, Łokaj M, Skoczylas MM, Donotek M, Kołaczyk K. Massive Upper Gastrointestinal Bleeding from a Splenic Artery Pseudoaneurysm Caused by a Penetrating Gastric Ulcer: Case Report and Review of Literature. Pol J Radiol 2015; 80:384-7. [PMID: 26309450 PMCID: PMC4538884 DOI: 10.12659/pjr.894465] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 06/02/2015] [Indexed: 12/12/2022] Open
Abstract
Background Splenic artery aneurysm and pseudoaneurysm are rare pathologies. True aneurysms are usually asymptomatic. Aneurysm rupture occurring in 2–3% of cases results in bleeding into the lesser sack, peritoneal space or adjacent organs typically presenting as abdominal pain and hemodynamic instability. In contrast, pseudoaneurysms are nearly always symptomatic carrying a high risk of rupture of 37–47% and mortality rate of 90% if untreated. Therefore, prompt diagnosis and treatment are essential in the management of patients with splenic artery pseudoaneurysm. Typical causes include pancreatitis and trauma. Rarely, the rupture of a pseudoaneurysm presents as upper gastrointestinal (UGI) bleeding. Among causes, peptic ulcer is the casuistic one. Case Report This report describes a very rare case of recurrent UGI bleeding from a splenic artery pseudoaneurysm caused by a penetrating gastric ulcer. After negative results of endoscopy and ultrasound, the diagnosis was established in CT angiography. The successful treatment consisted of surgical ligation of the bleeding vessel and suture of the ulcer with preservation of the spleen and pancreas, which is rarely tried in such situations. Conclusions The most important factor in identifying a ruptured splenic artery pseudoaneurysm as a source of GI bleeding is considering the diagnosis. UGI hemorrhage from splenic artery pseudoaneurysm can have a relapsing course providing false negative results of endoscopy and ultrasound if performed between episodes of active bleeding. In such cases, immediate CT angiography is useful in establishing diagnosis and in application of proper therapy before possible recurrence.
Collapse
Affiliation(s)
- Marcin Sawicki
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Norbert Czapla
- Clinic of Plastic, Endocrine and General Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Marek Łokaj
- Clinic of Plastic, Endocrine and General Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Michał M Skoczylas
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland
| | - Maciej Donotek
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Kołaczyk
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland
| |
Collapse
|
12
|
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: 2] [Impact Index Per Article: 0.2] [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.
Collapse
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
| |
Collapse
|
13
|
Emergency Treatment of Haemorrhaging Coeliac or Mesenteric Artery Aneurysms and Pseudoaneurysms in the Era of Endovascular Management. Eur J Vasc Endovasc Surg 2015; 49:382-9. [DOI: 10.1016/j.ejvs.2014.12.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 12/13/2014] [Indexed: 11/23/2022]
|
14
|
Abstract
Arterial pseudoaneurysm formation of visceral arteries as a vascular complication of pancreatitis, either acute or chronic, is an uncommon phenomenon. This review article discusses the incidence, pathophysiology, imaging, treatment strategies, and prognosis of mesenteric pseudoaneurysms complicating pancreatitis.
Collapse
|
15
|
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: 28] [Impact Index Per Article: 2.8] [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.
Collapse
|
16
|
Kukliński A, Batycki K, Matuszewski W, Ostrach A, Kupis Z, Lęgowik T. Embolization of a large, symptomatic splenic artery pseudoaneurysm. Pol J Radiol 2014; 79:194-8. [PMID: 25009678 PMCID: PMC4089775 DOI: 10.12659/pjr.889974] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 01/31/2014] [Indexed: 01/30/2023] Open
Abstract
Background Splenic artery aneurysm is the third most common abdominal aneurysm. Most often it is due to pancreatitis. There were only 19 cases of aneurysms larger than 5 cm in diameter described in the literature. Management of splenic artery aneurysms depends on the size and symptoms. Invasive treatment modalities involve open procedures and interventional radiology methods (endovascular). Case Reports A 44-years-old male with chronic pancreatitis, in a gradually worsening general condition due to a large splenic artery aneurysm, was subjected to the procedure. Blood flow through the aneurysm was cut-off by implanting a covered stent between celiac trunk and common hepatic artery. Patient’s general condition rapidly improved, allowing discharge home in good state soon after the procedure. Conclusions Percutaneous embolization appears to be the best method of treatment of large splenic artery aneurysms. Complications of such treatment are significantly less dangerous than those associated with surgery.
Collapse
Affiliation(s)
- Adam Kukliński
- Department of Surgery, Radom Specialist Hospital, Radom, Poland
| | - Krzysztof Batycki
- Department of Diagnostic Imaging, Radom Specialist Hospital, Radom, Poland
| | | | - Andrzej Ostrach
- Department of Surgery, Radom Specialist Hospital, Radom, Poland
| | - Zbigniew Kupis
- Department of Surgery, Radom Specialist Hospital, Radom, Poland
| | - Tomasz Lęgowik
- Department of Diagnostic Imaging, Radom Specialist Hospital, Radom, Poland
| |
Collapse
|
17
|
Abstract
Peripheral arterial aneurysms are uncommon; for some aneurysm types, data are limited to case reports and small case series. There is no Level A evidence in most cases to determine the choice between open or endovascular intervention. The evolution of endovascular technology has vastly improved the armamentarium available to the vascular surgeon and interventionalists in the management of these rare and unusual aneurysms. The choice of operative approach will ultimately be determined on an individual basis, dependent on the patient risk factors, and aneurysm anatomy. After consideration, some aneurysms (femoral, subclavian, carotid and ECAA) fare better with an open first approach; renal, splenic and some visceral artery aneurysms do better with an endovascular first approach. In our practice PAAs are treated with an endovascular first approach. For these rare conditions, both open and endovascular therapy will continue to work in harmony to enhance and extend the capabilities of modern surgical management.
Collapse
Affiliation(s)
- Irwin V Mohan
- Westmead Hospital, University of Sydney Medical School, Sydney, NSW 2145, Australia.
| | | |
Collapse
|
18
|
Roberts KJ, Jones RG, Forde C, Marudanayagam R. Endoscopic ultrasound-guided treatment of visceral artery pseudoaneurysm. HPB (Oxford) 2012; 14:489-90. [PMID: 22672553 PMCID: PMC3384881 DOI: 10.1111/j.1477-2574.2012.00470.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | - Robert G Jones
- Department of Radiology, University Hospitals BirminghamBirmingham, UK
| | - Colm Forde
- Department of Radiology, University Hospitals BirminghamBirmingham, UK
| | | |
Collapse
|
19
|
Percutaneous ultrasound-guided thrombin injection of a post-traumatic pancreatic pseudoaneurysm in a pediatric patient. Pediatr Surg Int 2012; 28:95-8. [PMID: 21969234 DOI: 10.1007/s00383-011-2981-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2011] [Indexed: 10/17/2022]
Abstract
Non-operative management for blunt injuries to the proximal pancreas has become increasingly common. A bleeding pseudoaneurysm in the setting of a traumatic pancreatic pseudocyst presents a morbid operation. We present the case of a 15-year old with a grade V pancreatic injury that developed a bleeding pseudoaneurysm successfully treated with percutaneous ultrasound-guided thrombin injection.
Collapse
|
20
|
A visceral pseudoaneurysm: management by EUS-guided thrombin injection. Gastrointest Endosc 2011; 73:392-5. [PMID: 20630509 DOI: 10.1016/j.gie.2010.05.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 05/08/2010] [Indexed: 01/11/2023]
|
21
|
Anévrisme de l’artère splénique : diagnostic et thérapeutique endovasculaire. ACTA ACUST UNITED AC 2010; 91:1103-11. [DOI: 10.1016/s0221-0363(10)70155-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
22
|
Singhal M, Lal A, Kochhar R, Dutta U, Nagi B, Wig JD, Singh K. Disruption of both dorsal and ventral ducts in a patient with pancreas divisum presenting with two pseudocysts. Clin J Gastroenterol 2009; 2:115-118. [PMID: 26192176 DOI: 10.1007/s12328-008-0050-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2008] [Accepted: 10/24/2008] [Indexed: 12/01/2022]
Abstract
A 35-year-old man, a chronic alcohol consumer with clinical features of acute pancreatitis, presented with obstructive jaundice and melena. On radiological evaluation two large pseudocysts, one each in relation to pancreatic head and tail regions, were noted with a gastro-duodenal artery pseudoaneurysm in the pseudocyst in the head region. He also had narrowing of the common bile duct. On endoscopic retrograde cholangiopancreatography (ERCP) he had evidence of chronic pancreatitis with morphology of pancreas divisum with disruption of both the dorsal and ventral ducts. After the relieving of bile duct obstruction with endoscopically placed stent, he underwent surgery for the pseudoaneurysm and the two pseudocysts. The case highlights the rare occurrence of both dorsal and ventral ductal disruption in a patient with pancreas divisum. ERCP was helpful in providing the diagnosis and guiding further management.
Collapse
Affiliation(s)
- Manphool Singhal
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Anupam Lal
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Birinder Nagi
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Jai Dev Wig
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Kartar Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| |
Collapse
|
23
|
McErlean A, Looby S, Lee MJ. Percutaneous ultrasound-guided thrombin injection as first-line treatment of pancreatic pseudoaneurysm. Cardiovasc Intervent Radiol 2007; 30:526-8. [PMID: 17131209 DOI: 10.1007/s00270-006-0174-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Pancreatic pseudoaneurysms are a rare but potentially fatal complication of pancreatitis. Surgical intervention and transcatheter embolization are not always feasible therapeutic options. In this report we present a case of a pseudoaneurysm secondary to pancreatitis which, despite being angiographically invisible, was successfully embolized with a single ultrasound-guided percutaneous injection of thrombin.
Collapse
MESH Headings
- Amylases/blood
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/therapy
- Angiography, Digital Subtraction
- Embolization, Therapeutic
- Hepatitis, Alcoholic/complications
- Humans
- Injections, Intralesional
- Male
- Middle Aged
- Pancreas/blood supply
- Thrombin/administration & dosage
- Tomography, Spiral Computed
- Ultrasonography, Doppler, Color
- Ultrasonography, Doppler, Pulsed
- Ultrasonography, Interventional
Collapse
Affiliation(s)
- Aoife McErlean
- Department of Radiology, Beaumont Hospital, Dublin 9, Ireland
| | | | | |
Collapse
|
24
|
Shah NA, Akingboye A, Haldipur N, Mackinlay JY, Jacob G. Embolization Coils Migrating and Being Passed per Rectum After Embolization of a Splenic Artery Pseudoaneurysm, “The Migrating Coil”: A Case Report. Cardiovasc Intervent Radiol 2007; 30:1259-62. [PMID: 17882482 DOI: 10.1007/s00270-007-9166-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Revised: 08/02/2007] [Accepted: 08/28/2007] [Indexed: 10/22/2022]
Abstract
Acute or chronic blood loss from pseudoaneurysms of the splanchnic artery in chronic pancreatitis poses diagnostic and management challenges. Arteriographic examination offers both diagnostic and therapeutic options, with success rates of 76%-100% for both modalities. In cases of failure of embolization, repeat embolization is also an option. Surgical intervention is advocated for rebleeding and failure of embolization. Evidence-based guidelines regarding the optimal treatment modality for this condition are lacking. There has been a reported case of dislodgement of coil into the stomach through a gastropseudocystic fistula. We report the case of a migrating steel-wire coil through the gastrointestinal tract and splenic artery pseudoaneurysm. We highlight the potential complications of pseudoaneurysm and other available therapeutic management options.
Collapse
Affiliation(s)
- Numan A Shah
- Doncaster and Bassetlaw NHS Trust, Doncaster Royal Infirmary, Thorne Road, Doncaster, South Yorkshire DN2 5LT, UK
| | | | | | | | | |
Collapse
|
25
|
Mansueto G, Cenzi D, D'Onofrio M, Salvia R, Gottin L, Gumbs AA, Pozzi Mucelli R. Endovascular treatment of arterial bleeding in patients with pancreatitis. Pancreatology 2007; 7:360-9. [PMID: 17703083 DOI: 10.1159/000107396] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Accepted: 02/21/2007] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess the technical and clinical success of endovascular treatment of arterial bleeding in pancreatitis. MATERIALS AND METHODS From 1992 to 2005, 28 patients with pancreatitis underwent endovascular treatment of associated arterial lesions. Fifteen patients were affected by acute pancreatitis and 13 by chronic pancreatitis. The diagnosis was obtained according to medical history and clinical and laboratory evidence of disease. Arterial involvement was diagnosed by non-invasive imaging and angiography. After treatment, all patients underwent CT scanning at a minimum of 15, 30 and 90 days. We evaluated the feasibility of embolization and patients' survival at 90 days. RESULTS Transcatheter embolization was feasible in 26/28 patients (93%). In 2 patients with acute pancreatitis, selective catheterization failed so we could not proceed with the angiographic approach. After treatment, there were 3/26 rebleeds (11.5%), all of whom died within the first week. At 90 days' follow-up, 21/26 patients (81%) were alive. Two of 26 patients (8%) suffered splenic complications. Among the 13 patients with acute pancreatitis, 8 (61.5%) were alive after 90 days. All 13 patients with chronic pancreatitis were alive after 90 days. CONCLUSIONS Comparing our results with the surgical literature, we found that embolization is less invasive and, at least, as successful as surgery. Thus, it should be considered the first choice in pancreatitis arterial complications.
Collapse
Affiliation(s)
- G Mansueto
- Department of Morphological and Biomedical Sciences, Radiology Institute, University of Verona, Verona, Italy.
| | | | | | | | | | | | | |
Collapse
|
26
|
Agrawal GA, Johnson PT, Fishman EK. Splenic Artery Aneurysms and Pseudoaneurysms: Clinical Distinctions and CT Appearances. AJR Am J Roentgenol 2007; 188:992-9. [PMID: 17377035 DOI: 10.2214/ajr.06.0794] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Aneurysms of the splenic artery are being diagnosed with greater frequency as incidental findings on cross-sectional imaging. Splenic artery pseudoaneurysms are even more rare than true aneurysms. This article reviews the clinical features and management of splenic artery aneurysms and pseudoaneurysms. A variety of cases are presented to show the range of CT appearances. CONCLUSION Radiologists who identify either type of splenic artery lesion should recognize the clinical and pathophysiologic distinctions between these two forms of splenic vascular pathology and understand the differences in management.
Collapse
Affiliation(s)
- Gautam A Agrawal
- Department of Radiology, Johns Hopkins School of Medicine, 601 N Caroline St., Rm. 3251, Baltimore, MD 21287, USA
| | | | | |
Collapse
|
27
|
Imaging and Intervention in Acute Pancreatic Conditions. Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
28
|
Carrafiello G, Laganà D, Recaldini C, Mangini M, Lumia D, Giorgianni A, Leonardi A, Fugazzola C. Combined percutaneous thrombin injection and endovascular treatment of gastroduodenal artery pseudoaneurysm (PAGD): case report. Emerg Radiol 2007; 14:51-4. [PMID: 17265027 DOI: 10.1007/s10140-007-0574-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Accepted: 12/28/2006] [Indexed: 01/26/2023]
Abstract
A 69-year-old man with a history of acute pancreatitis developed a huge pseudoaneurysm of the gastroduodenal artery (PAGD), as diagnosed by CT scan. The PAGD was treated by percutaneous thrombin injection (2,000 IU) under ultrasound guidance and selective embolization of gastroduodenal artery with microcoils with its complete exclusion. The 6-month follow-up confirmed the complete exclusion of the PAGD sac.
Collapse
Affiliation(s)
- Gianpaolo Carrafiello
- Department of Radiology, University of Insubria, Viale Borri, 57, 21100 Varese, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Nicholson AA, Patel J, McPherson S, Shaw DR, Kessel D. Endovascular treatment of visceral aneurysms associated with pancreatitis and a suggested classification with therapeutic implications. J Vasc Interv Radiol 2006; 17:1279-85. [PMID: 16923974 DOI: 10.1097/01.rvi.0000231948.08617.04] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To describe a 10-year experience of endovascular and percutaneous treatment of aneurysms and pseudoaneurysms complicating pancreatitis, and to analyze this experience and propose a classification based on computed tomography (CT) and angiographic findings that has therapeutic implications. This may reduce the rate of recurrent bleeding after surgery or endovascular treatment. MATERIALS AND METHODS Twenty-three patients with aneurysms or pseudoaneurysms associated with acute pancreatitis were treated by endovascular or percutaneous methods. All underwent CT and angiography. The early development of a simple classification based on the CT and angiographic findings was used to guide treatment decisions. In accordance with this classification, 19 patients were treated by primary coil embolization and four were treated by primary percutaneous thrombin injection. RESULTS Among the 19 patients treated by primary coil embolization, there were two early recurrences of the pseudoaneurysm. All four patients treated by percutaneous thrombin injection exhibited late recurrences and were successfully treated by percutaneous thrombin injections. Twenty-one patients (91.3%) were alive at 6 months. CONCLUSIONS Endovascular and percutaneous treatment of aneurysms and pseudoaneurysms complicating pancreatitis is safe and effective and is associated with good outcomes, but careful follow-up is necessary. The decision of which treatment option is most appropriate can be made in accordance with a classification based on CT and angiographic appearance.
Collapse
Affiliation(s)
- Anthony A Nicholson
- Radiology Department, Leeds Teaching Hospitals, Great George Street, Leeds LS1 3EX, United Kingdom.
| | | | | | | | | |
Collapse
|
30
|
Laganà D, Carrafiello G, Mangini M, Dionigi G, Caronno R, Castelli P, Fugazzola C. Multimodal approach to endovascular treatment of visceral artery aneurysms and pseudoaneurysms. Eur J Radiol 2006; 59:104-11. [PMID: 16597492 DOI: 10.1016/j.ejrad.2006.02.004] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2005] [Revised: 12/08/2005] [Accepted: 02/06/2006] [Indexed: 12/17/2022]
Abstract
PURPOSE To assess the feasibility and the effectiveness of endovascular treatment of visceral arteries aneurysms (VAAs) using a "multimodal approach". MATERIAL AND METHODS Twenty-five patients (mean age 60.1 years) with 29 VAAs (13 splenic, 4 hepatic, 3 gastroduodenal, 6 renal, 2 pancreatic-duodenal, 1 superior mesenteric) were considered suitable for endovascular treatment; 8/29 were ruptured. Saccular aneurysms (9/29) were treated by sac embolization with coils (in 4 cases associated with cyanoacrylate or thrombin) with preservation of artery patency. Fusiform aneurysms (6/29), were treated by an "endovascular exclusion". In 10/29 cases, supplied by a terminal branch, we performed an embolization of the afferent artery, with coils and cyanoacrylate or thrombin. 2/29 cases were treated with a stent-graft and 2/29 cases with a percutaneous ultrasound-guided thrombin injection and coils embolization of the afferent artery. The follow-up was performed by ultrasonography and/or CT-angiography 1 week after the procedure and then after 1, 6, and 12 months and thereafter annually. RESULTS In 29/29 cases we obtained an immediate exclusion. Two patient died for other reasons. Complication rate was 27.6% (7 spleen ischemia and 1 stent-graft occlusion). During the follow-up (range: 7 days-36 months, mean 18.7 months), we observed 3/29 (10.3%) cases of reperfusion in the first month, all treated successfully with a further endovascular procedure. Primary technical success was 89.7%; secondary technical success was 100%. CONCLUSION Endovascular therapy can be considered a feasible and effective approach for VAAs with good primary and secondary success rates.
Collapse
Affiliation(s)
- Domenico Laganà
- Vascular and Interventional Radiology, Department of Radiology, University of Insubria, Varese, Italy
| | | | | | | | | | | | | |
Collapse
|
31
|
Oechsle S, Vollert K, Buecklein W, Michl W, Roemer FW. Percutaneous treatment of a ruptured superior mesenteric artery aneurysm in a child. Pediatr Radiol 2006; 36:268-71. [PMID: 16432702 DOI: 10.1007/s00247-005-0078-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2005] [Revised: 11/13/2005] [Accepted: 11/14/2005] [Indexed: 10/25/2022]
Abstract
Splanchnic artery aneurysms are very rare in children. We report a 10-year-old girl with a large atraumatic ruptured superior mesenteric artery aneurysm that was considered inoperable. She was ultimately treated with two percutaneous US-guided thrombin injections, which led to complete occlusion of the aneurysm. The aetiology of the aneurysm remained unclear, but a family history was suggestive of a congenital connective tissue disease such as Ehlers-Danlos syndrome subtype IV.
Collapse
Affiliation(s)
- Susanne Oechsle
- Department of Radiology, Klinikum Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany.
| | | | | | | | | |
Collapse
|
32
|
Krueger K, Zaehringer M, Lackner K. Percutaneous treatment of a splenic artery pseudoaneurysm by thrombin injection. J Vasc Interv Radiol 2005; 16:1023-5. [PMID: 16002512 DOI: 10.1097/01.rvi.0000162167.54455.c0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Pseudoaneurysms in the visceral arteries are rare complications of pancreatitis. In the reported case, a 42-year-old man with a splenic pseudoaneurysm was successfully treated by computed tomography (CT)-guided direct thrombin injection into the pseudoaneurysm lumen. Selective catheterization of the splenic artery had proven technically impossible. During the procedure, contrast medium was injected via a pigtail catheter into the aorta for planning, correct positioning of the needle tip, and control imaging after injection. CT examinations 1 day, 3 weeks, and 6 months after treatment demonstrated complete occlusion shrinkage of the pseudoaneurysm, and the patient was symptom-free.
Collapse
Affiliation(s)
- Karsten Krueger
- Department of Radiology, University of Cologne, Joseph-Stelzmann-Str., 50924 Cologne, Germany.
| | | | | |
Collapse
|
33
|
Hung RK, Loh C, Goldstein L. Selective use of electrolytic detachable and fibered coils to embolize a wide-neck giant splenic artery pseudoaneurysm. J Vasc Surg 2005; 41:889-92. [PMID: 15886676 DOI: 10.1016/j.jvs.2005.02.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report on a 55-year-old woman with recurrent chronic pancreatitis complicated by a 7-cm splenic artery pseudoaneurysm. A therapeutic endovascular treatment was chosen because of the patient's high surgical risk. Initial embolization with fibered coils succeeded in thrombosing the aneurysm lumen, but the aneurysm neck remained patent. Further embolization was achieved with two detachable Gugliemi Detachable Coils (GDCs) deployed across the aneurysm neck, successfully thrombosing the residual aneurysm. GDCs complement the more thrombogenic traditional fibered coils and should be used advantageously in critical locations to embolize difficult splenic artery pseudoaneurysms.
Collapse
Affiliation(s)
- Raymond K Hung
- Santa Clara Valley Medical Center, San Jose, CA 95128, USA.
| | | | | |
Collapse
|
34
|
Geoghegan T, Tuite D, McAuley G, O'Keeffe S, Torreggiani WC. Percutaneous thrombin injection for the treatment of a post-pancreatitis pseudoaneurysm of the gastroduodenal artery. Eur Radiol 2004; 14:2144-5. [PMID: 15278409 DOI: 10.1007/s00330-004-2399-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2004] [Accepted: 04/15/2004] [Indexed: 12/17/2022]
|