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Jhajharia A, Singh S, Chaudhary M, Ameta M, Ashdhir P, Nijhawan S. Efficacy and Rationale of Endoscopic Ultrasound-Guided Thrombin Injection in Visceral Artery Pseudoaneurysm Not Amenable to Angioembolization. Pancreas 2024; 53:e330-e337. [PMID: 38345925 DOI: 10.1097/mpa.0000000000002303] [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: 03/24/2024]
Abstract
BACKGROUND Pseudoaneurysm usually occurs after vascular injuries or erosions such as in trauma or inflammation like pancreatitis and is associated with high morbidity and mortality. AIM The aim of study is to assess efficacy and safety of EUS-guided thrombin injection in pseudoaneurysm. MATERIALS AND METHODS Prospective data collection was done at SMS Hospital, Jaipur, from January 2015 to March 2023. All patients with pseudoaneurysm were consecutively enrolled. RESULTS Twenty patients (M/F, 18:2) with median age of 41 years (25-58 years), were studied. Underlying etiology of pseudoaneurysm was chronic pancreatitis in 75% of the patients, blunt trauma abdomen in 15% of the patients, recurrent acute pancreatitis in 5%, and idiopathic in 5% of the patients. At the time of admission, mean hemoglobin was 6.7 g/dL (3.4-8.2), with median blood transfusion requirement was 2 units (0-6 units). Hemoglobin values after 4-6 weeks showed a significant improvement ( t = 9.21, P < 0.05).Mean dose of human thrombin required for complete obliteration of pseudoaneurysm was 520 ± 188.6 IU per patient (300-800 IU). Amount of thrombin (IU) dose needed to achieve complete obliteration correlated well significantly with the dimension of pseudoaneurysm, P value less than 0.05 ( R = 0.80). Median follow-up duration in this study was 44 months (3-84 months), which was the longest follow-up period by far. CONCLUSIONS Endoscopic ultrasound-guided thrombin injection in visceral artery pseudoaneurysm is a safe and effective alternative for patients not amenable for digital subtraction angiography-guided angioembolization.
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Affiliation(s)
- Ashok Jhajharia
- From the Department of Gastroenterology, SMS Medical College and Hospital
| | - Shashank Singh
- From the Department of Gastroenterology, SMS Medical College and Hospital
| | - Monika Chaudhary
- Department of Radiology, Santokba Durlabhji Memorial Hospital, Jaipur, India
| | - Mayank Ameta
- From the Department of Gastroenterology, SMS Medical College and Hospital
| | - Prachis Ashdhir
- From the Department of Gastroenterology, SMS Medical College and Hospital
| | - Sandeep Nijhawan
- From the Department of Gastroenterology, SMS Medical College and Hospital
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Muglia R, Marra P, Dulcetta L, Carbone FS, Bonaffini PA, Sironi S. US-guided percutaneous thrombin injection to treat non-femoral artery pseudoaneurysms: preliminary experience and review of the literature. LA RADIOLOGIA MEDICA 2023; 128:125-131. [PMID: 36525178 DOI: 10.1007/s11547-022-01576-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate the clinical outcome of US-guided percutaneous thrombin injection in the treatment of non-femoral artery pseudoaneurysms (NFAP). MATERIALS AND METHODS Among all pseudoaneurysms treated in our institution, we retrospectively collected NFAP embolized with percutaneous thrombin injections from January 1, 2015, to December 31, 2021. The embolization was prompted for an ongoing antiaggregating/anticoagulation therapy, NFAP optimal US visibility, or high surgery-related risks. Causes, location, size and neck of NFAP, complications, number of repeated treatments, clinical success and patients clinical conditions at discharge were annotated. The endpoint for clinical success was the resolution of NFAP at postprocedural imaging, with no resort to surgery. RESULTS Eight consecutive patients (5 females, median age 73 years, range 46-84) underwent 16 procedures. Arterial damage was due to catheterization (3), CVC mispositioning (2), trauma, hemorrhagic diathesis and endoprosthesis endoleak. We treated humeral (2), subclavian (2), thyrocervical, anterior tibial, radial and pancreaticoduodenal arteries. Median pseudoaneurysm size was 530 mm2 (range 32-2400 mm2), with a thin (7/8) or non-visible (1/8) neck. No complications occurred. Clinical success was obtained in 7/8 patients (88%), with a single treatment in 4, multiple in 3 cases (4 embolizations, 3 and 2, respectively). One patient underwent surgical suture after the second failed attempt of percutaneous embolization. Seven patients were discharged in good clinical conditions; one died during hospitalization, due to the worsening of the underlying cardiac disease. CONCLUSIONS Percutaneous US-guided thrombin injection to treat NFAP is feasible in selected cases, with rare complications. Clinical success is often reached, also by repeated injections.
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Affiliation(s)
- Riccardo Muglia
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy.
- School of Medicine, University of Milano-Bicocca, Milan, Italy.
| | - Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Ludovico Dulcetta
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Francesco Saverio Carbone
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Pietro Andrea Bonaffini
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
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Han C, Ling X, Liu J, Lin R, Ding Z. Management of non-variceal upper gastrointestinal bleeding: role of endoscopic ultrasound-guided treatments. Therap Adv Gastroenterol 2022; 15:17562848211056148. [PMID: 35126666 PMCID: PMC8808014 DOI: 10.1177/17562848211056148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/08/2021] [Indexed: 02/04/2023] Open
Abstract
Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common type of upper gastrointestinal emergency with high risk of life-threatening conditions. Nowadays some standard guidelines for the treatments of NVUGIB have been established based on endoscopic therapies, including injection of glues or sclerosing agents, coiling, band ligation, and thermal therapies. Nevertheless, some patients are refractory to standard endoscopic treatments. We have noticed that endoscopic ultrasound (EUS)-guided treatments have been performed by some endoscopists in certain conditions. This review aims to evaluate the role of EUS-guided treatments in the management of NVUGIB. We performed a MEDLINE/PubMed search, and relevant studies were extracted and examined. According to the existing literature, the most common lesions were Dieulafoy's lesion, pancreatic pseudoaneurysms, and gastrointestinal stromal tumors. EUS-guided treatments mainly include injection, mechanical therapies, and combined therapies, and seem to be a promising technique in the management of NVUGIB, especially for refractory bleeding.
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Affiliation(s)
- Chaoqun Han
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Ling
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Liu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rong Lin
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, Hubei, China
| | - Zhen Ding
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, Hubei, China
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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
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Gorsi U, Agarwal V, Yaser M, Kalra N, Chaluvashetty S, Kang M, Lal A, Sandhu MS. Utility of percutaneous thrombin injection for treating visceral pseudoaneurysms. MINIM INVASIV THER 2020; 30:174-178. [DOI: 10.1080/13645706.2020.1720251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ujjwal Gorsi
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
| | - Vivek Agarwal
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
| | - Mohamed Yaser
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
| | - Naveen Kalra
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
| | | | - Mandeep Kang
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
| | - Anupam Lal
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
| | - MS Sandhu
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
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Gupta V, Irrinki S, Sakaray YR, Moond V, Yadav TD, Kochhar R, Khandelwal N, Wig JD. Treatment strategies for bleeding from gastroduodenal artery pseudoaneurysms complicating the course of chronic pancreatitis-A case series of 10 patients. Indian J Gastroenterol 2018; 37:457-463. [PMID: 30374751 DOI: 10.1007/s12664-018-0897-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/19/2018] [Indexed: 02/04/2023]
Abstract
We analyzed our experience with management of gastroduodenal artery (GDA) pseudoaneurysms associated with chronic pancreatitis using a multidisciplinary approach. We treated 10 patients with GDA pseudoaneurysms (all men, aged 24-62 year) who underwent treatment during April 1998 to December 2016. All had presented with recent hematemesis and/or melena. Hemodynamically, stable patients were initially subjected to transcatheter embolization or radiologically guided thrombin injection. Recurrence of bleeding within 48 h was taken as failure. Emergency surgery was done for hemodynamic instability and recurrent bleeding, and elective surgery was carried out as per specific indications. Ten interventional procedures were performed in nine patients, while one was directly subjected to surgery. Angioembolization was done in five patients (with success in four) and thrombin injection in five patients (including one with embolization failure; with success in three). Six patients underwent surgery, two on emergency basis, for hemodynamic instability and recurrent bleeding in one each, and four for definitive treatment of pancreatitis/associated complication. One patient died while the other nine survived and well with no recurrence of bleeding during follow up (6 months to 10 years). Management of GDA pseudoaneurysms requires a multidisciplinary approach. Pseudoaneurysms with narrow neck are suitable for thrombin injection while those with wide neck should be subjected to angioembolization. Emergency surgical treatment is reserved for non-surgical failures, and choice between trans-ductal or trans-cystic approach is based on the location of the aneurysm.
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Affiliation(s)
- Vikas Gupta
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India.
| | - Santhosh Irrinki
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Yashwanth Raj Sakaray
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Vikash Moond
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Thakur Deen Yadav
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Jai Dev Wig
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
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8
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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: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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.
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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
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9
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Lee FM, Khoo JF, Edelstein S, Croagh DG. Common bile duct obstruction secondary to gastroduodenal pseudoaneurysm. ANZ J Surg 2018; 89:974-976. [PMID: 29405614 DOI: 10.1111/ans.14404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/22/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Felix M Lee
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeremy F Khoo
- Department of Surgery, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
| | - Simon Edelstein
- Department of Interventional Radiology, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
| | - Daniel G Croagh
- Department of Surgery, Monash Health, Melbourne, Victoria, Australia
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10
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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: 4.4] [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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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: 0.8] [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.
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12
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Gamanagatti S, Thingujam U, Garg P, Nongthombam S, Dash NR. Endoscopic ultrasound guided thrombin injection of angiographically occult pancreatitis associated visceral artery pseudoaneurysms: Case series. World J Gastrointest Endosc 2015; 7:1107-1113. [PMID: 26421108 PMCID: PMC4580953 DOI: 10.4253/wjge.v7.i13.1107] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 05/24/2015] [Accepted: 08/31/2015] [Indexed: 02/05/2023] Open
Abstract
Pseudoaneurysm is a known complication of pancreatitis associated with significant mortality and morbidity. Imaging plays an important role in the diagnosis and management. Computed tomography (CT) helps localize the lesion and the severity of the background pancreatitis but digital subtraction angiography with coil embolization is recommended to avoid bleeding and inadvertent surgery. However, in cases where angiographic coil embolization is not feasible due to technical reasons, thrombin injection via CT or ultrasound guidance remains a viable option and often described in literature. In this series, effort has been made to highlight the role of endoscopic ultrasound guided thrombin instillation especially in patients with poorly visualized pseudoaneurysm on ultrasound thereby avoiding surgery and the associated mortality and morbidity.
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13
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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: 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.
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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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14
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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: 30] [Impact Index Per Article: 2.7] [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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15
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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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Barge JU, Lopera JE. Vascular complications of pancreatitis: role of interventional therapy. Korean J Radiol 2012; 13 Suppl 1:S45-55. [PMID: 22563287 PMCID: PMC3341460 DOI: 10.3348/kjr.2012.13.s1.s45] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 12/05/2011] [Indexed: 12/12/2022] Open
Abstract
Major vascular complications related to pancreatitis can cause life-threatening hemorrhage and have to be dealt with as an emergency, utilizing a multidisciplinary approach of angiography, endoscopy or surgery. These may occur secondary to direct vascular injuries, which result in the formation of splanchnic pseudoaneurysms, gastrointestinal etiologies such as peptic ulcer disease and gastroesophageal varices, and post-operative bleeding related to pancreatic surgery. In this review article, we discuss the pathophysiologic mechanisms, diagnostic modalities, and treatment of pancreatic vascular complications, with a focus on the role of minimally-invasive interventional therapies such as angioembolization, endovascular stenting, and ultrasound-guided percutaneous thrombin injection in their management.
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Affiliation(s)
- Jaideep U Barge
- Diagnostic and Interventional Radiology at University of Texas Health Science Center at San Antonio, San Antonio, TX 78249, USA.
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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.
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18
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Splenic artery pseudoaneurysm as a complication of pancreatic pseudocyst. VOJNOSANIT PREGL 2011; 68:602-6. [PMID: 21899182 DOI: 10.2298/vsp1107602m] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Pancreatic pseudocyst presented as pseudoaneurysm of the splenic artery is a potential serious complication in patients with chronic pancreatitis. CASE REPORT A 42-year-old male patient with a long-standing evolution of chronic pancreatitis and 8-year long evolution of pancreas pseudocyst was referred to the Military Medical Academy, Belgrade due to worsening of the general condition. At admission, the patient was cachectic, febrile, and had the increased values of amylases in urine and sedimentation (SE). After clinical and diagnostic examination: laboratory assessment, esophagogastroduodenoscopy (EGDS), ultrasonography (US), endoscopic ultrasonography (EUS), multislice computed scanner (MSCT) angiography, pseudoaneurysm was found caused by the conversion of pseudocyst on the basis of chronic pancreatitis. The patient was operated on after founding pancreatic pseudocyst, which caused erosion of the splenic artery and their mutual communication. Postoperative course was duly preceded without complications with one year follow-up. CONCLUSION Angiography is the most reliable and the safest method for diagnosing hemorrhagic pseudocysts when they clinically present as pseudoaneurysms. A potentially dangerous complication in the presented case was treated surgically with excellent postoperative results.
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19
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Pacheco Jiménez M, Moreno Sánchez T, Moreno Rodríguez F, Guillén Rico M. [Pancreatic tail pseudoaneurysm: percutaneous treatment by thrombin injection]. RADIOLOGIA 2011; 56:167-70. [PMID: 21944714 DOI: 10.1016/j.rx.2011.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 03/30/2011] [Accepted: 04/01/2011] [Indexed: 12/21/2022]
Abstract
Visceral artery pseudoaneurysms secondary to acute and/or chronic pancreatitis are a relatively common and potentially serious complication. Endovascular techniques are the most currently accepted techniques, given the higher morbidity-mortality of surgery. The thrombosis of the pseudoaneurysm using an ultrasound-guided percutaneous thrombin injection is emerging as a useful option in those cases in which endovascular embolisation is not possible. We present the case of a patient with a pseudoaneurysm of the transverse pancreatic artery secondary to chronic pancreatitis, and successfully treated by administering percutaneous thrombin.
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Affiliation(s)
- M Pacheco Jiménez
- Servicio de Radiodiagnóstico, Hospital Juan Ramón Jiménez, Huelva, España
| | - T Moreno Sánchez
- Servicio de Radiodiagnóstico, Hospital Juan Ramón Jiménez, Huelva, España.
| | - F Moreno Rodríguez
- Servicio de Radiodiagnóstico, Hospital Juan Ramón Jiménez, Huelva, España
| | - M Guillén Rico
- Servicio de Radiodiagnóstico, Hospital Juan Ramón Jiménez, Huelva, España
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20
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21
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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: 0.2] [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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22
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Hanson JM, Atri M, Power N. Ultrasound-guided thrombin injection of iatrogenic groin pseudoaneurysm: Doppler features and technical tips. Br J Radiol 2008; 81:154-63. [PMID: 18238924 DOI: 10.1259/bjr/52029321] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The practice of angiographic procedures is increasing and, concomitantly, there has been an increase in the incidence of iatrogenic femoral pseudoaneurysms (PA). Ultrasound-guided thrombin injection is becoming the accepted gold standard in the treatment of PA. It is a cost-effective, safe and efficacious treatment that requires a short learning curve. The aim of this pictorial review is to demonstrate the Doppler and ultrasound features used to diagnose PA and those that help differentiate it from alternative diagnoses, and to describe the procedure of thrombin injection, highlighting technical tips and ways to avoid potential complications.
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Affiliation(s)
- J M Hanson
- Department of Rodiology, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland.
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23
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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: 1.3] [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.
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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
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Affiliation(s)
- Aoife McErlean
- Department of Radiology, Beaumont Hospital, Dublin 9, Ireland
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24
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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; 7:360-369. [PMID: 17703083 DOI: 10.1159/000107396] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [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.
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Affiliation(s)
- G Mansueto
- Department of Morphological and Biomedical Sciences, Radiology Institute, University of Verona, Verona, Italy.
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25
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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]
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26
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Stawicki SP, Hoey BA. Lower extremity arterial thrombosis following sonographically guided thrombin injection of a femoral pseudoaneurysm. JOURNAL OF CLINICAL ULTRASOUND : JCU 2007; 35:88-93. [PMID: 16960880 DOI: 10.1002/jcu.20268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Sonographically guided percutaneous thrombin injection is a minimally invasive and highly successful treatment of arterial pseudoaneurysms. Despite a very low complication rate, several severe arterial thrombotic events have been reported following thrombin injection of pseudoaneurysms. Native arterial thrombosis, though recognized as a severe complication of thrombin injection, has not been well described in the literature. We report a case of successful surgical management of arterial thrombosis after percutaneous thrombin injection of a femoral artery pseudoaneurysm in a 69-year-old woman. The pathophysiology, risk factors, diagnosis, and treatment options for this complication are discussed.
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Affiliation(s)
- Stanislaw P Stawicki
- Department of Surgery, St. Luke's Hospital and Health Network, 801 Ostrum Street, Bethlehem, PA 18015, USA
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27
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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: 2.3] [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.
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Affiliation(s)
- Anthony A Nicholson
- Radiology Department, Leeds Teaching Hospitals, Great George Street, Leeds LS1 3EX, United Kingdom.
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28
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Williams M, Alderson D, Virjee J, Callaway M. CT-guided percutaneous thrombin injection for treatment of an inferior pancreaticoduodenal artery pseudoaneurysm. Cardiovasc Intervent Radiol 2006; 29:669-71. [PMID: 16604412 DOI: 10.1007/s00270-004-0274-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We present a case of an inferior pancreaticoduodenal artery pseudoaneurysm treated by computed tomography (CT)-guided percutaneous injection of thrombin. As far as we are aware, we present the first documented case of successful long-term (9 months) follow-up with no evidence of recurrence.
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Affiliation(s)
- Marc Williams
- Department of Surgery, Bristol Royal Infirmary, Bristol, UK
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29
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Ghassemi A, Javit D, Dillon EH. Thrombin injection of a pancreaticoduodenal artery pseudoaneurysm after failed attempts at transcatheter embolization. J Vasc Surg 2006; 43:618-22. [PMID: 16520183 DOI: 10.1016/j.jvs.2005.11.051] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2005] [Accepted: 11/29/2005] [Indexed: 12/17/2022]
Abstract
We describe a case of a pseudoaneurysm of the pancreaticoduodenal artery in a patient with history of cholecystectomy and chronic pancreatitis. Attempts at transcatheter coil embolotherapy failed because of vessel tortuosity. The lesion was then successfully treated by computed tomography-guided direct percutaneous injection of thrombin into the pseudoaneurysm. This technique may be a first line of treatment or a useful adjunct to transcatheter embolization technique.
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Affiliation(s)
- Azad Ghassemi
- Lenox Hill Hospital, Department of Radiology, New York, NY 10021, USA.
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30
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Khera G, Shea AJ, Parkinson R, Lambrianides AL. Delayed Diagnosis of a Gluteal Pseudoaneurysm Caused by Blunt Trauma: Review of the Literature and Presentation of a Case Report. ACTA ACUST UNITED AC 2006; 60:644-7. [PMID: 16531869 DOI: 10.1097/01.ta.0000204937.60174.84] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- G Khera
- Department of Surgery, Redcliffe Hospital, Queensland, Australia.
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31
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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: 8] [Impact Index Per Article: 0.4] [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.
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Affiliation(s)
- Susanne Oechsle
- Department of Radiology, Klinikum Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany.
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32
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Szopiński P, Ciostek P, Pleban E, Iwanowski J, Serafin-Król M, Marianowska A, Noszczyk W. Percutaneous thrombin injection to complete SMA pseudoaneurysm exclusion after failing of endograft placement. Cardiovasc Intervent Radiol 2005; 28:509-14. [PMID: 16010511 DOI: 10.1007/s00270-004-0160-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Visceral aneurysms are potentially life-threatening vascular lesions. Superior mesenteric artery (SMA) pseudoaneurysms are a rare but well-recognized complication of chronic pancreatitis. Open surgical repair of such an aneurysm, especially in patients after previous surgical treatment, might be dangerous and risky. Stent graft implantation makes SMA pseudoaneurysm exclusion possible and therefore avoids a major abdominal operation. Percutaneous direct thrombin injection is also one of the methods of treating aneurysms in this area. We report a first case of percutaneous ultrasound-guided thrombin injection to complete SMA pseudoaneurysm exclusion after an unsuccessful endograft placement. Six-month follow-up did not demonstrate any signs of aneurysm recurrence.
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Affiliation(s)
- Piotr Szopiński
- Clinic of General and Vascular Surgery, Warsaw Medical University, ul.Kondratowicza 8, 03 242 Warsaw, Poland.
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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: 1.3] [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.
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Affiliation(s)
- Karsten Krueger
- Department of Radiology, University of Cologne, Joseph-Stelzmann-Str., 50924 Cologne, Germany.
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34
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Corso R, Carrafiello G, Rampoldi A, Leni D, Ticca C, Vercelli R, Vanzulli A. Pseudoaneurysm after spontaneous rupture of renal angiomyolipoma in tuberous sclerosis: successful treatment with percutaneous thrombin injection. Cardiovasc Intervent Radiol 2005; 28:262-4. [PMID: 15719182 DOI: 10.1007/s00270-004-0154-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a case of a large perinephric pseudoaneurysm due to spontaneous rupture of renal angiomyolipoma, occluded by percutaneous thrombin injection under ultrasound guidance in a young woman affected by tuberous sclerosis.
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Affiliation(s)
- Rocco Corso
- Department of Diagnostic and Interventional Radiology, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
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35
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Young R, Gagandeep S, Grant E, Palmer S, Mateo R, Selby R, Genyk Y, Jabbour N. Gastroduodenal artery pseudoaneurysm secondary to pancreatic head biopsy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:997-1001. [PMID: 15292573 DOI: 10.7863/jum.2004.23.7.997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Ryan Young
- Division of Hepatobiliary/Pancreatic Surgery and Abdominal Organ Transplantation, University of Southern California, University Hospital, Los Angeles, California, USA
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