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Sasaki K, Okada T, Yamaguchi M, Tajiri M, Ahmed M, Gentsu T, Ueshima E, Sofue K, Sugimoto K, Murakami T. Major and minor complications of the pancreas after transcatheter arterial embolization using n-butyl-2-cyanoacrylate for acute bleeding from pancreatic arteries. Jpn J Radiol 2021; 40:308-317. [PMID: 34613557 DOI: 10.1007/s11604-021-01203-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose is to investigate the major and minor complications of the pancreas after transcatheter arterial embolization (TAE) using n-butyl-2-cyanoacrylate (NBCA) for bleeding from pancreatic arteries. MATERIALS AND METHODS Thirty-three patients who underwent TAE using NBCA for acute bleeding from pancreatic arteries and their parent arteries followed by contrast-enhanced computed tomography (CE-CT) were evaluated retrospectively. Complications and risk factors were assessed using Mann-Whitney U test or Fisher's exact test for the univariate analysis. Patients' characteristic, embolized artery, procedure details, and clinical outcomes were examined as possible risk factors. RESULTS TAE was performed successfully in all patients. Minor pancreatic complications occurred in 10 patients (30%), including acute mild pancreatitis (n = 4) and focal lack of pancreatic parenchymal enhancement on CE-CT without pancreatitis (n = 6). No cases of major pancreatic complications, such as moderate/severe pancreatitis, were reported. Embolized artery was the only significant risk factor. The rate of complications per embolized artery were 15% (three out of 20 patients) in the arteries of the pancreatic head and 54% (seven out of 13 patients) in the arteries of pancreatic body and tail (p = 0.025). CONCLUSION TAE using NBCA for acute bleeding from pancreatic arteries is efficacious and safe. Mild pancreatic complications were observed more frequently in case of embolization of the pancreatic body and tail region than the pancreatic head.
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Affiliation(s)
- Koji Sasaki
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Takuya Okada
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan.
| | - Masato Yamaguchi
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Masashi Tajiri
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Mostafa Ahmed
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Tomoyuki Gentsu
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Eisuke Ueshima
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Koji Sugimoto
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
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Madhusudhan KS, Gopi S, Singh AN, Agarwal L, Gunjan D, Srivastava DN, Garg PK. Immediate and Long-Term Outcomes of Percutaneous Radiological Interventions for Hemorrhagic Complications in Acute and Chronic Pancreatitis. J Vasc Interv Radiol 2021; 32:1591-1600.e1. [PMID: 34416367 DOI: 10.1016/j.jvir.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/03/2021] [Accepted: 08/09/2021] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate and compare the immediate and long-term outcomes of radiological interventions for hemorrhagic complications in patients with acute and chronic pancreatitis. MATERIALS AND METHODS This retrospective study, conducted between January 2014 and June 2020, included all patients with acute and chronic pancreatitis presenting with hemorrhagic complications who underwent angiography and/or embolization. Their clinical, angiographic, and embolization details were evaluated and correlated with procedure success, complications, recurrence, and mortality. The patients were subgrouped into groups A (acute pancreatitis) and C (chronic pancreatitis), and comparisons were made. RESULTS The study included 141 patients (mean age, 36.3 ± 11.2 years; 124 men), of whom 106 patients had abnormal angiography findings and underwent embolization. Of them, group A had 50 patients (56 lesions) and group C had 56 patients (61 lesions). All the patients in group A had severe acute pancreatitis, with a mean computed tomography severity index of 7.6. The technical and clinical success rates of embolization, complications, recurrence, and long-term outcomes were not significantly different between the groups. Group A had significantly higher mortality due to sepsis and organ failure. Embolic agents did not have any significant association with complications, recurrence, and mortality. After a mean follow-up of 2 years, 72.5% of the patients were asymptomatic, and none had symptoms attributable to embolization. CONCLUSIONS Success, complications, and recurrence after embolization for hemorrhagic complications were comparable between acute and chronic pancreatitis. Acute pancreatitis was associated with significantly higher mortality. Embolic agents did not significantly influence the outcomes. None had long-term adverse effects attributable to embolization.
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Affiliation(s)
- Kumble Seetharama Madhusudhan
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Srikanth Gopi
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Anand Narayan Singh
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Lokesh Agarwal
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Gunjan
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Deep N Srivastava
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
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Method of diagnosis and treatment of profusional bleeding from stenosing postbulbar ulcers of the duodenum. EUREKA: HEALTH SCIENCES 2021. [DOI: 10.21303/2504-5679.2021.001730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim. To evaluate the effectiveness of X-ray interventions in arosive bleeding in patients with complicated duodenal ulcer.
Materials and methods. X-ray endovascular interventions were used in 8 patients who developed arosive bleeding as a complication of duodenal ulcer. All patients with signs of gastrointestinal bleeding were examined according to clinical protocols. Hemodynamically stable patients underwent X-ray endovascular interventions.
Results and discussion. In the near future, bleeding stopped in all 8 (100 %, OR–0.04 [0.005–0.29], p=0.03) patients. On day 2, two patients who underwent embolization of their own hepatic artery had a recurrence of bleeding (0.56 [0.065–4.76], p=0.29). Repeated angiography and embolization attempts were ineffective, and both patients died. In patients who underwent gastroduodenal and pancreatouodenal artery embolization, bleeding did not resume. Thus, we obtained good results as 6 out of 8 patients recovered (75 %), despite the severity of their condition and a disappointing prognosis (OR–9.0 [1.0–46.7], p <0.05).
Conclusions. Adherence to the tactics mentioned above in the treatment of bleeding in duodenal ulcer was highly effective, especially in superselective embolization with the detection of bleeding gel. If the presence of arosive bleeding is confirmed, emergency surgical treatment with suturing of the damaged vessel is shown in hemodynamically unstable patients, and endovascular intervention is possible in hemodynamically stable patients. Further studies are needed to determine the criteria for a high risk of arosive bleeding developing in patients with complicated duodenal ulcer as well as to prevent its occurrence through the use of X-ray endovascular interventions.
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Sagar S, Soundarajan R, Gupta P, Praveen Kumar M, Samanta J, Sharma V, Kochhar R. Efficacy of endovascular embolization of arterial pseudoaneurysms in pancreatitis: A systematic review and meta-analysis. Pancreatology 2021; 21:46-58. [PMID: 33303372 DOI: 10.1016/j.pan.2020.11.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/16/2020] [Accepted: 11/22/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is a significant variability in the reported outcomes following endovascular embolization of arterial pseudoaneurysms in pancreatitis. The objective of this systematic review and meta-analysis is to evaluate the efficacy of endovascular embolization of pancreatitis-related pseudoaneurysms. METHODS Searches of MEDLINE, EMBASE, and SCOPUS databases were performed through July 1, 2019 in accordance with PRISMA guidelines. All studies with ≥10 patients reporting technical success, clinical success, complications, and mortality were included. Generalized linear mixed method with random effects model was used for assessing pooled incidence rates and corresponding 95% confidence intervals (CIs). RESULTS A total of 29 studies (n = 840 with 638 pseudoaneurysms) were included. The pooled incidence rates of pseudoaneurysms in acute and chronic pancreatitis were 0.05% and 0.03%, respectively (odds ratio, 0.91, 95% CI-0.24-3.43). The most common site of pseudoaneurysm was splenic artery (37.7%). The most common embolization agent was coil (n = 415). The follow up period was 54.7 months (range, 21 days to 40.5 months). Pooled technical success rate was 97% (95% CI-92-99%, I2 83%). Clinical success rates at ≤3 months, 3-12 months, and >12 months were 82% (95% CI-70-90%, I2 42%), 86% (95% CI-75-92%, I2 44%), and 88% (95% CI-83-91%, I2 0%), respectively. There was no significant difference in the technical or clinical success between acute and chronic pancreatitis on subgroup analysis. Mortality was lower in chronic pancreatitis (OR 4.27 (95% CI 1.35-13.53, I2 0%)). Splenic infarction was the most common complication (n = 47). CONCLUSION Endovascular embolization is associated with a high technical and clinical success.
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Affiliation(s)
- Sathya Sagar
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Raghuraman Soundarajan
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Pankaj Gupta
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - M Praveen Kumar
- Department of Pharmacology, Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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Alhazemi AA, Park S, Shin JH, Cho YC, Kim Y, Lee J, Kim PH, Kim JW, Chu HH. Safety and efficacy of transarterial embolisation for treatment of dorsal pancreatic artery haemorrhage. Clin Radiol 2020; 76:314.e9-314.e15. [PMID: 33334554 DOI: 10.1016/j.crad.2020.11.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/12/2020] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the safety and efficacy of transarterial embolisation (TAE) of dorsal pancreatic artery (DPA) haemorrhage. MATERIALS AND METHODS Nineteen consecutive patients (M:F = 16:3, mean age 59.6 years) who underwent TAE of DPA in three tertiary medical centres between January 2001 to January 2020 were reviewed retrospectively. Angiographic features and the technical and clinical outcomes of TAE were analysed. RESULTS The clinical presentations were a bloody drain from the Jackson-Pratt drainage tube (n=8), melaena (n=7), abdominal pain (n=4), and haematochezia (n=3). Angiographic findings included pseudoaneurysm (n=14), contrast media extravasation (n=4), or abrupt cut-off of the arterial branch (n=1). The NBCA (N-butyl-cyanoacrylate; n=4), microcoils (n=4), and a combination of these agents (n=7) were used as embolic agents. The most common origin of the DPA in the present study cohort was the splenic artery (n=7), followed by the coeliac trunk (n=4), common hepatic artery (n=4), and superior mesenteric artery (n=4). Technical and clinical success rates were 100% and 84.2% (16/19), respectively. Of the three clinically unsuccessful cases, two patients were revealed to have newly developed bleeding from another artery. The other patient expired 1 day after the TAE procedure due to a progression of hepatic failure. In one patient, an asymptomatic non-target embolisation occurred in the right posterior tibial artery as a procedure-related complication. No major complications were observed. CONCLUSION TAE is safe and effective for the management of bleeding from the DPA. It is important to be aware of the DPA as a potential bleeding source, including the relevant clinical characteristics.
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Affiliation(s)
- A A Alhazemi
- Department of Radiology, King Fahd Central Hospital, Jazan 45196, Saudi Arabia
| | - S Park
- Department of Radiology, Gil Medical Centre, Gachon University College of Medicine, Incheon, Republic of Korea
| | - J H Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Y C Cho
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Y Kim
- Department of Radiology Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - J Lee
- Department of Radiology Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - P H Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J W Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - H H Chu
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Kumar S, Singh JR, Kumar MT, Nagbhushan K, Reddy ND, Rao G. Endovascular Management of Pancreatitis-Related Hemorrhage: Single-Center Experience. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2020. [DOI: 10.1055/s-0040-1705290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Abstract
Purpose The main purpose of this article is to assess the outcomes of endovascular management of pancreatitis-related hemorrhage.
Materials and Methods Retrospective analysis of patients referred for endovascular management of pancreatitis-related bleeding from January 2010 to December 2017 was performed. Patients’ demographics, clinical presentation, etiology, laboratory findings, angiography findings, details of the endovascular procedure, technical outcome, clinical outcome, and complications were assessed.
Results One hundred and five patients with a mean age of 37 years were included in this study. Splenic artery (41.7%) was the most commonly involved vessel. Middle colic, left colic, superior mesenteric, jejunal, left inferior phrenic, and left renal subcapsular arteries were the less commonly involved vessels. Embolization was performed using coils in 72 (68.5%) patients, n-butyl cyanoacrylate (n-BCA) in 21 (20%) patients, both coil and n-BCA in 8 (7.6%) patients, and 4 (3.8%) patients underwent stent graft placement. Technical success was achieved in 98% (n = 103) and clinical success in 93.2% (n = 96) of patients. Rebleeding was seen in 6.8% (n = 7) of patients. Six patients with rebleeding were managed by reintervention. Four patients had rebleeding from the same vessel, and two patients had rebleeding from a different vessel. One patient died due to massive rebleeding. Minor complications were seen in 14.2% (n = 15), major complications were seen in 3.8% (n = 4), and mortality rate was 0.9% (n = 1).
Conclusion Endovascular treatment is effective in the management of pancreatitis-related bleeding and is associated with low rebleeding rate and low mortality rate.
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Affiliation(s)
- Sunil 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 T. 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
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Israrahmed A, Singh S, Boruah DK, Yadav RR. Glue Embolization of Adrenal Artery Pseudoaneurysm: Case Series with Review of Literature. J Clin Imaging Sci 2020; 10:20. [PMID: 32363082 PMCID: PMC7193146 DOI: 10.25259/jcis_23_2020] [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: 02/24/2020] [Accepted: 03/25/2020] [Indexed: 11/04/2022] Open
Abstract
Mortality rates for pseudoaneurysm (PSA) rupture are high and immediate intervention in the form of embolization can be life saving for the patient. Adrenal artery PSAs are rare with scarce references in literature. These arteries are small in caliber and require modification of the cannulation techniques for endovascular access. In situations, where the distal artery cannot be cannulated or the ostium cannot be negotiated, and percutaneous direct needle puncture (PDNP) techniques can be used. We discuss two patients with adrenal artery PSA that presented to us and their successful embolization with N-butyl cyanoacrylate through endovascular and PDNP techniques along with relevant review of the literature.
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Affiliation(s)
- Amrin Israrahmed
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh,
| | - Somesh Singh
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh,
| | - Deb K. Boruah
- Department of Radiodiagnosis, Tejpur Medical College and Hospital, Tejpur, Assam, India,
| | - Rajanikant R. Yadav
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh,
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Zhang C, Li A, Luo T, Li J, Liu D, Cao F, Li J, Li F. Strategy and management of severe hemorrhage complicating pancreatitis and post-pancreatectomy. ACTA ACUST UNITED AC 2019; 25:81-89. [PMID: 30582573 DOI: 10.5152/dir.2018.18283] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Transcatheter arterial embolization (TAE) is increasingly used as the first-line treatment for hemorrhage complicating pancreatitis and post-pancreatectomy. However, the optimal therapeutic strategy remains unclear. METHODS Among 1924 consecutive patients, 40 patients with severe pancreatic hemorrhage in Xuanwu Hospital were enrolled between 2005 and 2017. Patients underwent angiography and direct TAE for primary diagnosis and treatment of bleeding. Repeat TAE, watch and wait, and laparotomy were used as the other therapeutic options. Patient data, technical success, and 90-day survival were identified. RESULTS Pancreatic diseases underlying hemorrhage included acute pancreatitis (n=19, 47.5%), chronic pancreatitis (n=12, 30%), and pancreatic cancer (n=9, 22.5%). A history of percutaneous catheter drainage or pancreatic surgery was seen in 29 patients (72.5%). There were 48 angiographies, 31 embolizations, and 5 laparotomies performed. Rebleeding occurred in 8 patients (20%); 4 of whom underwent re-embolization, 3 had laparotomy, and 1 had conservative treatment. Successful clinical hemostasis was achieved in 37 patients. Complications were observed in only 2 patients with renal failure and 1 patient with hepatic insufficiency. In total, 25 patients (62.5%) were alive at the 90-day follow-up. CONCLUSION Endovascular management is effective for achieving hemostasis in severe pancreatic hemorrhage with a high success rate and low recurrence, and laparotomy is not suitable for rebleeding cases.
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Affiliation(s)
- Chao Zhang
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ang Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Luo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jia Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Diangang Liu
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Feng Cao
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianxin Li
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Mallick B, Malik S, Gupta P, Gorsi U, Kochhar S, Gupta V, Yadav TD, Dhaka N, Sinha SK, Kochhar R. Arterial pseudoaneurysms in acute and chronic pancreatitis: Clinical profile and outcome. JGH OPEN 2018; 3:126-132. [PMID: 31061887 PMCID: PMC6487818 DOI: 10.1002/jgh3.12116] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 11/03/2018] [Indexed: 12/19/2022]
Abstract
Objective To evaluate the clinical profile and outcome of arterial pseudoaneurysms (PSA) associated with acute and chronic pancreatitis (CP). Methods Records of all patients of pancreatitis from 2010 to 2016 were analyzed retrospectively for the development PSAs; clinical profile and outcome parameters were compared between PSAs associated with acute and CP. Results Of the 980 patients, 46 (all males, age 39.70 ± 11.78 years) developed PSAs, including 19 of 600 of acute pancreatitis (AP) and 27 of 380 of CP. The most common clinical presentation was bleeding (37, 80.4%). The majority of patients was managed nonsurgically, with endovascular embolization in 31 (67.4%) and percutaneous thrombin injection in 9 (19.6%) patients. Pseudoaneurysms in patients with AP were associated more often with fluid collections (94.7% vs. 55.6%, P = 0.004) with more requirement of surgery compared to patients with CP (15.8% vs. 3.7%, P = 0.033). The pattern of arteries involved with PSAs and outcome was similar in AP and CP patients. Conclusion Arterial PSAs were more commonly associated with CP compared to AP with similar presentations. Associated fluid collections and requirement of surgical intervention were higher in PSAs in patients with AP compared to patients with CP.
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Affiliation(s)
- Bipadabhanjan Mallick
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Sarthak Malik
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Pankaj Gupta
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Ujjwal Gorsi
- Department of Radiodiagnosis Postgraduate Institute of Medical Education and Research Chandigarh India
| | | | - Vikas Gupta
- Department of General Surgery Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Thakur Deen Yadav
- Department of General Surgery Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Narendra Dhaka
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Saroj K Sinha
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Rakesh Kochhar
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
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Noh SY, Shin JH. Endovascular treatment of pancreatitis-related gastrointestinal bleeding. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2018. [DOI: 10.18528/gii180032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Seung Yeon Noh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Yamaguchi H, Murata S, Onozawa S, Sugihara F, Saito H, Kumita SI. Coil embolization using microballoon assistance combined with the double-catheter technique for a large superior mesenteric arterial pseudoaneurysm and fistula secondary to acute pancreatitis. J Vasc Surg Cases Innov Tech 2018; 4:152-155. [PMID: 29942908 PMCID: PMC6012999 DOI: 10.1016/j.jvscit.2018.02.009] [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: 11/22/2017] [Accepted: 02/16/2018] [Indexed: 11/08/2022] Open
Abstract
Pseudoaneurysm of the superior mesenteric artery (SMA) is rare and associated with the risk of massive fatal hemorrhage and acute mesenteric ischemia. We describe a 43-year-old man with acute pancreatitis who presented with an SMA pseudoaneurysm measuring 13 × 12 cm in diameter. The pseudoaneurysm originated between the first and second jejunal arteries and drained into the mesenteric vein. The SMA trunk between the first and second jejunal arteries was embolized with detachable coils using microballoon assistance. After coil placement, arteriography showed the collateral circulation and no perfusion delay of the distal SMA. This technique was useful for isolation of the SMA pseudoaneurysm.
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Fang Y, Han X, Liu L, Lou W. Diagnosis and treatment efficacy of digital subtraction angiography and transcatheter arterial embolization in post-pancreatectomy hemorrhage: A single center retrospective cohort study. Int J Surg 2018; 51:223-228. [DOI: 10.1016/j.ijsu.2018.01.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/17/2018] [Accepted: 01/27/2018] [Indexed: 01/08/2023]
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Gabrielli D, Taglialatela F, Mantini C, Giammarino A, Modestino F, Cotroneo AR. Endovascular Treatment of Visceral Artery Pseudoaneurysms in Patients with Chronic Pancreatitis: Our Single-Center Experience. Ann Vasc Surg 2017; 45:112-116. [PMID: 28602898 DOI: 10.1016/j.avsg.2017.05.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/23/2017] [Accepted: 05/23/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND To analyze our experience in endovascular treatment as first-line approach for severe and acute hemorrhage in patients with chronic pancreatitis. METHODS From 2010 to 2016 at our institution, 12 males (mean age 66 years) with bleeding pseudoaneurysms (PSAs) underwent urgent visceral angiography and endovascular treatment. All patients had chronic pancreatitis. True visceral artery aneurysms and PSAs arising after surgery were excluded from the study. RESULTS Pancreatitis was caused by alcohol abuse in 9 (9/12, 75%) patients and biliary lithiasis in 3 (3/12, 25%). Involved arteries were gastroduodenal (5/12, 50%), splenic (2/12, 16%), common hepatic (2/12, 16%), middle colic (1/12, 9%), and celiac trunk (1/12, 9%). All patients underwent computed tomography angiography (CTA) scan and visceral angiography followed by endovascular treatment using different devices. Technical success rate was 100%. Bleeding was stopped in all patients, and no one required reembolization. No major complications occurred. There were 2 complications associated with the endovascular procedure: in one case, a coil migration and in another case, in-stent restenosis at 6 months. Follow-up included CTA performed during hospitalization and at 6 months after the procedure. CONCLUSIONS Our experience confirms the role of CTA and visceral angiography as diagnostic and therapeutic tool, respectively.
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Affiliation(s)
- Daniela Gabrielli
- Department of Neuroscience and Imaging, Institute of Radiology, Section of Diagnostic Imaging and Therapy-Radiology Division, "G. d'Annunzio" University, Chieti-Pescara, Italy.
| | - Francesco Taglialatela
- Department of Neuroscience and Imaging, Institute of Radiology, Section of Diagnostic Imaging and Therapy-Radiology Division, "G. d'Annunzio" University, Chieti-Pescara, Italy
| | - Cesare Mantini
- Department of Neuroscience and Imaging, Institute of Radiology, Section of Diagnostic Imaging and Therapy-Radiology Division, "G. d'Annunzio" University, Chieti-Pescara, Italy
| | - Alberto Giammarino
- Department of Neuroscience and Imaging, Institute of Radiology, Section of Diagnostic Imaging and Therapy-Radiology Division, "G. d'Annunzio" University, Chieti-Pescara, Italy
| | - Francesco Modestino
- Radiology Unit, Department of Diagnostic Medicine and Prevention, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonio Raffaele Cotroneo
- Department of Neuroscience and Imaging, Institute of Radiology, Section of Diagnostic Imaging and Therapy-Radiology Division, "G. d'Annunzio" University, Chieti-Pescara, Italy
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Vander Mijnsbrugge W, Laleman W, Van Steenbergen W, Heye S, Verslype C, Maleux G. Long-term clinical and radiological outcome of endovascular embolization of pancreatitis-related pseudoaneurysms. Acta Radiol 2017; 58:316-322. [PMID: 27178033 DOI: 10.1177/0284185116648502] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Long-term outcome after embolization of pancreatitis-induced pseudoaneurysm is not yet determined. Purpose To assess the long-term efficacy and patients' overall survival after embolization of pancreatitis-induced pseudoaneurysm. Material and Methods Patients referred for endovascular treatment of a pancreatitis-induced pseudoaneurysm between January 1998 and January 2014 were analyzed. Embolization procedures were performed by transcatheter techniques using different types of embolic agents. Demographic, technical-radiological, and clinical data were collected. Results Thirty-four patients were identified with a pancreatitis-induced pseudoaneurysm; the underlying disease was acute (n = 13; 38%) or chronic (n = 21; 62%) pancreatitis; seven patients (20.6%) had active bleeding when embolized, while in the remaining 27 patients (79.4%) the pseudoaneurysm was not bleeding. In all 34 patients, successful endovascular exclusion of the pseudoaneurysm was obtained after the first attempt. Minor complications occurred in 11 patients (30%); no major complications were noted. A new pseudoaneurysm on a different vessel was identified during follow-up in three patients (9%). In another patient (3%), the excluded pseudoaneurysm reopened during follow-up. All four recurrences occurred within the first 5 months after embolization. Long-term follow-up (mean, 6.6 years; range, 4 months-16 years) revealed estimated survival rates of 94%, 89%, and 75% after 2, 5, and 10 years respectively, without pseudoaneurysm-related death. Conclusion Catheter-directed embolization of pancreatitis-induced pseudoaneurysms is relatively safe and effective. Recurrence or new pseudoaneurysm formation was low and occurred within the first 6 months after embolization. Overall survival is high, with no pseudoaneurysm-related deaths.
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Affiliation(s)
| | - Wim Laleman
- Department of Hepatology, University Hospitals Leuven, Belgium
| | | | - Sam Heye
- Department of Radiology, University Hospitals Leuven, Belgium
| | - Chris Verslype
- Department of Hepatology, University Hospitals Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Belgium
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Spezia L, Sozzi C, Contro A, Mansueto G. Successful Post-Pancreatitis Pseudoaneurysm Coagulation by Percutaneous Computed Tomography (CT)-Guided Thrombin Injection. Pol J Radiol 2017; 82:24-27. [PMID: 28203308 PMCID: PMC5266204 DOI: 10.12659/pjr.899431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 05/27/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Pseudoaneurysm is a rare but potentially life-threatening vascular complication of acute pancreatitis, with a mortality rate of 20-43% in untreated patients. The treatment usually involves trans-arterial embolization or surgical resection. CASE REPORT A 44-year-old man with a history of acute pancreatitis developed a pseudoaneurysm of the pancreatic tail, diagnosed as a splenic artery pseudoaneurysm by CT. Selective arteriography performed with the purpose of embolization did not reveal the pseudoaneurysm. The day after, under CT guidance, human thrombin (1,000 IU) was injected inside the aneurysmatic sac with its complete occlusion. A control MRI 6 months later confirmed a complete resolution of the pseudoaneurysm. CONCLUSIONS Percutaneous coagulation of a post-pancreatitis pseudoaneurysm is a relatively easy and safe procedure, and it can be considered as an alternative to trans-arterial embolization when the pseudoaneurysm cannot be visualized on selective arteriography.
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Affiliation(s)
- Laura Spezia
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Carlo Sozzi
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Alberto Contro
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Giancarlo Mansueto
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
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Kim J, Shin JH, Yoon HK, Ko GY, Gwon DI, Kim EY, Sung KB. Endovascular intervention for management of pancreatitis-related bleeding: a retrospective analysis of thirty-seven patients at a single institution. Diagn Interv Radiol 2016; 21:140-7. [PMID: 25616269 DOI: 10.5152/dir.2014.14085] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of this study was to assess the outcome of endovascular intervention for pancreatitis-related hemorrhage at a single institution. METHODS From January 2000 to October 2012, thirty-seven patients underwent endovascular intervention for the management of pancreatitis-related hemorrhage. The underlying etiology of the disease, clinical symptoms and laboratory findings, abnormalities seen on computed tomography, and details regarding the endovascular procedures were assessed, as were the outcome of each procedure and procedure-related complications. RESULTS A total of 41 endovascular procedures were performed in 37 patients. The splenic artery (34.8%) was the most commonly treated artery, and pseudoaneurysm was the most commonly detected abnormality on digital subtraction angiography (78.3%). Transcatheter embolization was performed in the majority of patients (95.1%), while two patients were treated with stent-grafts. Successful hemostasis without rebleeding was achieved in 34 patients (91.9%). Two cases of rebleeding were successfully treated by reintervention. Focal splenic infarction, which developed in eight patients, was either asymptomatic or accompanied by mild, transient fever. Splenic abscess was the only major complication occurring in three patients. Two of these patients died from resulting sepsis, while the third recovered after antibiotic treatment. CONCLUSION Endovascular management is effective for achieving hemostasis in patients with pancreatitis-related bleeding and demonstrates low recurrence and mortality rates.
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Affiliation(s)
- Jinoo Kim
- Department of Radiology, Ajou University, School of Medicine, Ajou University Hospital, Suwon, Korea.
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17
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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: 0.9] [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.
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Pezzilli R, Zerbi A, Campra D, Capurso G, Golfieri R, Arcidiacono PG, Billi P, Butturini G, Calculli L, Cannizzaro R, Carrara S, Crippa S, De Gaudio R, De Rai P, Frulloni L, Mazza E, Mutignani M, Pagano N, Rabitti P, Balzano G. Consensus guidelines on severe acute pancreatitis. Dig Liver Dis 2015; 47:532-43. [PMID: 25921277 DOI: 10.1016/j.dld.2015.03.022] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/17/2015] [Accepted: 03/24/2015] [Indexed: 02/07/2023]
Abstract
This Position Paper contains clinically oriented guidelines by the Italian Association for the Study of the Pancreas (AISP) for the diagnosis and treatment of severe acute pancreatitis. The statements were formulated by three working groups of experts who searched and analysed the most recent literature; a consensus process was then performed using a modified Delphi procedure. The statements provide recommendations on the most appropriate definition of the complications of severe acute pancreatitis, the diagnostic approach and the timing of conservative as well as interventional endoscopic, radiological and surgical treatments.
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19
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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.
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20
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Ierardi AM, Petrillo M, Capasso R, Fontana F, Bacuzzi A, Duka E, Laganà D, Carrafiello G. Urgent endovascular ligature of a ruptured splenic artery pseudoaneurysm in a patient with acute pancreatitis: a case report. J Med Case Rep 2015; 9:6. [PMID: 25575735 PMCID: PMC4326335 DOI: 10.1186/1752-1947-9-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 11/25/2014] [Indexed: 11/30/2022] Open
Abstract
Introduction We report on the successful endovascular treatment of a ruptured splenic artery pseudoaneurysm. Our patient had acute pancreatitis superimposed on chronic calcific pancreatitis and chronic renal impairment. Contrast-enhanced ultrasonography was used to assess post-embolization results. Case presentation Our patient was a 67-year-old white Caucasian man with recurrent pancreatitis. Computed tomography angiography showed a pancreatic pseudocyst with a ruptured pseudoaneurysm, which was successfully embolized using an endovascular percutaneous approach. At six months, persistent renal failure led to contrast-enhanced ultrasonography. This confirmed the absence of turbulent blood flow and extravasation of contrast medium in the pseudocyst. Conclusion Our experience with this case leads us to support the role of interventional radiology as a first-line treatment tool. Contrast-enhanced ultrasonography can be used to follow-up embolization procedures in patients with impaired renal function.
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Affiliation(s)
| | | | | | | | | | | | | | - Gianpaolo Carrafiello
- Department of Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, 21100 Varese, VA, Italy.
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21
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Fitzpatrick J, Bhat R, Young JA. Angiographic embolization is an effective treatment of severe hemorrhage in pancreatitis. Pancreas 2014; 43:436-9. [PMID: 24622075 DOI: 10.1097/mpa.0000000000000051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the role of radiologic embolization as a diagnostic and therapeutic modality for severe hemorrhage in pancreatitis. METHODS All patients with pancreatitis who underwent mesenteric angiography for a 3-year period were identified and analyzed retrospectively. RESULTS Nine separate bleeding episodes were treated with embolization (mean age, 56 years). This consisted of 6 patients who underwent primary angiographic embolization, with 3 patients requiring further embolization because of repeated bleeding from a different site. Most patients (83%) had chronic disease. The causative arteries were identified as splenic (6/9 patients), gastroduodenal (1/9 patients), left gastric (1/9 patients), and a small branch of the inferior mesenteric (1/9 patients). Clinical presentations were abdominal pain (3/9 patients), melena (3/9 patients), bleeding into retroperitoneal drain (2/9 patients), and hematemesis (1/9 patients). Bleeding was severe with an average drop in hemoglobin level of 6.3 g/dL. Of the 3 patients who required further embolization, all had splenic artery pseudoaneurysms and 2 patients experienced chronic pancreatitis with necrosis and proven peripancreatic infections. In all cases (9/9 patients), angiography succeeded in identifying and embolizing the causative vessel with a 1-year mortality of 0%. CONCLUSIONS Angiographic embolization is an effective treatment of the life-threatening bleeding that occurs secondary to pancreatitis.
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Affiliation(s)
- John Fitzpatrick
- From the Departments of *Surgery, and †Radiology, Ninewells Hospital, Dundee, Scotland, United Kingdom
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22
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Pang TCY, Maher R, Gananadha S, Hugh TJ, Samra JS. Peripancreatic pseudoaneurysms: a management-based classification system. Surg Endosc 2014; 28:2027-38. [PMID: 24519028 PMCID: PMC4065337 DOI: 10.1007/s00464-014-3434-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 01/09/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Peripancreatic pseudoaneurysms can arise in a number of different clinical settings but are associated mostly with pancreatitis and pancreatobiliary surgery. The aim of this study is to review the current literature and to propose a management classification system based on the pathophysiological processes and the exact anatomical site of peripancreatic pseudoaneurysms. METHODS A systematic review of the literature from 1995 to 2012 was performed. Articles on studies describing peripancreatic pseudoaneurysms in the setting of pancreatitis or major hepatic or pancreatic surgery with more than ten patients were included. Seventeen eligible studies were identified and reviewed. RESULTS The demographic characteristics of the patients in all studies were similar with a predominance of males and a mean age of 55 years. The overall mortality rate varied greatly among the studies, ranging from 0 to 60%. Embolisation was the first line of management in the majority of the studies, with surgery reserved for failed embolisation or for haemodynamically unstable cases. Embolisation of the hepatic artery or its branches was associated with high rates of morbidity (56%) and hepatic failure (19%). More recent studies show that stents are used increasingly for vessels that cannot be embolised safely. Late bleeding, a major cause of mortality and morbidity, is generally underreported. The proposed classification system is based on three factors: (1) the type of artery from which the pseudoaneurysm arises, (2) whether communication with the gastrointestinal tract is present, and (3) whether there is high concentration of pancreatic juice at the bleeding site. CONCLUSION The management of peripancreatic pseudoaneurysms usually comprises a combination of interventional radiology and surgery and this may be assisted by a logical classification system.
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Affiliation(s)
- Tony C Y Pang
- Upper GI Surgical Unit, Royal North Shore Hospital and North Shore Private Hospitals, University of Sydney, St Leonards, NSW, 2065, Australia
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Skipworth JRA, Morkane C, Raptis DA, Kennedy L, Johal K, Pendse D, Brennand DJ, Olde Damink S, Malago M, Shankar A, Imber C. Coil migration--a rare complication of endovascular exclusion of visceral artery pseudoaneurysms and aneurysms. Ann R Coll Surg Engl 2011; 93:e19-23. [PMID: 21944789 DOI: 10.1308/003588411x13008844298652] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION We describe a case of metallic, angiographic coil migration, following radiological exclusion of a gastroduodenal artery pseudoaneurysm secondary to chronic pancreatitis. PATIENTS AND METHODS A 55-year-old man presented to the out-patient clinic with chronic, intermittent, post-prandial, abdominal pain, associated with nausea, vomiting and weight loss. He was known to have chronic pancreatitis and liver disease secondary to alcohol abuse and previously underwent angiographic exclusion of a gastroduodenal artery pseudoaneurysm. During subsequent radiological and endoscopic investigation, an endovascular coil was discovered in the gastric pylorus, associated with ulceration and cavitation. This patient was managed conservatively and enterally fed via naso-jejunal catheter endoscopically placed past the site of the migrated coil. This patient is currently awaiting biliary bypass surgery for chronic pancreatitis, and definitive coil removal will occur concurrently. CONCLUSIONS Literature review reveals that this report is only the eighth to describe coil migration following embolisation of a visceral artery pseudoaneurysm or aneurysm. Endovascular embolisation of pseudoaneurysms and aneurysms is generally safe and effective. More common complications of visceral artery embolisation include rebleeding, pseudoaneurysm reformation and pancreatitis.
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Affiliation(s)
- J R A Skipworth
- Department of Hepatopancreaticobiliary Surgery, University College London Hospital, UK.
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Chadha M, Ahuja C. Visceral artery aneurysms: diagnosis and percutaneous management. Semin Intervent Radiol 2011; 26:196-206. [PMID: 21326564 DOI: 10.1055/s-0029-1225670] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Visceral artery aneurysms (VAAs) and visceral artery pseudoaneurysms (VAPAs) frequently present as life-threatening emergencies. VAAs are now being diagnosed with increasing frequency, related to routine use of magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound. Both surgery as well as endovascular techniques are well established in their management. Endovascular management includes transarterial deployment of coils, N-butyl cyanoacrylate, or stent grafts. Direct percutaneous embolization of visceral aneurysms and pseudoaneurysms may also be performed. Special attention to aneurysmal etiology-congenital, atherosclerotic, infectious, and inflammatory is outlined. Advances in endovascular management with various aneurysmal isolation techniques are discussed. It is concluded that percutaneous endovascular management, now offers a safe and effective alternative to conventional surgery with lower procedural morbidity and mortality and high technical success rates.
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Affiliation(s)
- Meghna Chadha
- Department of Radiology, Detroit Medical Center, Wayne State University, Detroit, Michigan
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25
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Izaki K, Yamaguchi M, Kawasaki R, Okada T, Sugimura K, Sugimoto K. N-butyl cyanoacrylate embolization for pseudoaneurysms complicating pancreatitis or pancreatectomy. J Vasc Interv Radiol 2011; 22:302-8. [PMID: 21353983 DOI: 10.1016/j.jvir.2010.11.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 11/09/2010] [Accepted: 11/11/2010] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To evaluate the clinical effectiveness and safety of transcatheter arterial embolization with n-butyl cyanoacrylate (NBCA) for pseudoaneurysms complicating pancreatitis or pancreatectomy. MATERIALS AND METHODS Twelve procedures were performed in nine patients (seven men and two women; mean age, 60.6 years) for pseudoaneurysms that occurred secondary to pancreatitis or as a consequence of pancreatic juice leakage at the site of pancreatectomy. For embolization, NBCA was mixed with iodized oil at a ratio of 1:1-1:4; in one patient with failed selective catheterization of the target vessel, the mixture ratio was 1:9. Technical and clinical success rates, recurrent bleeding, procedural complications, serum amylase level, and clinical outcome were determined for each procedure. RESULTS Embolization was technically successful in all procedures, with no recurrent bleeding documented from the initially treated territory. In three procedures, we encountered additional bleeding vessels at 11, 33, and 49 days after the procedures, which were successfully managed by a second embolization in each case. There were no major complications related to the procedures. As minor complications, in two procedures, the embolized material overflowed beyond the target vessels; however, no clinically significant ischemic events were observed in the embolized territories. Serum amylase did not increase compared with initial levels after any of the procedures. Seven patients were discharged after clinical improvement. Two patients died 2 and 3 weeks after the embolization as a result of multiple organ failure not associated with the procedure. CONCLUSIONS In this limited series, NBCA embolization was found to be feasible and effective for pseudoaneurysms as a complication of pancreatitis or pancreatectomy.
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Affiliation(s)
- Kenta Izaki
- Department of Radiology and Center for Endovascular Therapy, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Japan.
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Watanabe S, Nitta N, Ohta S, Sonoda A, Otani H, Tomozawa Y, Nitta-Seko A, Tsuchiya K, Tanka T, Takahashi M, Murata K. Comparison of the anti-tumor effects of two platinum agents (miriplatin and fine-powder cisplatin). Cardiovasc Intervent Radiol 2011; 35:399-405. [PMID: 21584842 DOI: 10.1007/s00270-011-0172-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 04/18/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE This study was designed to evaluate the anti-tumor effects of miriplatin-lipidol and fine-powder cisplatin-lipiodol suspensions. METHODS Assessment of the cytotoxicity of two drugs was performed: a soluble derivative of miriplatin (DPC) and fine-powder cisplatin. We randomly divided 15 rabbits with transplanted VX2 liver tumors into three equal groups. They were infused via the proper hepatic artery with a miriplatin-lipiodol suspension (ML), a fine-powder cisplatin-lipiodol suspension (CL), or saline (control) and the tumor growth rate was determined on MR images acquired before and 7 days after treatment. The concentration of platinum (PCs) in blood was assayed immediately, and 10, 30, and 60 min, and 24 h and 7 days after drug administration. Its concentration in tumor and surrounding normal liver tissues was determined at 7 days postadministration. RESULTS At high concentrations, fine-powder cisplatin exhibited stronger cytotoxicity than DPC. At low concentrations, both agents manifested weak cytotoxicity. While there was no difference between the tumor growth rate of the ML and the CL groups, the difference between the controls and ML- and CL-treated rabbits was significant. The blood PCs peaked at 10 min and then gradually decreased over time. On the other hand, no platinum was detected at any point after the administration of ML. There was no difference between the ML and CL groups in the PCs in tumor tissues; however, in normal hepatic tissue, the PCs were higher in ML- than CL-treated rabbits. CONCLUSIONS We confirmed the anti-tumor effect of ML and CL. There was no significant difference between the anti-tumor effect of ML and CL at 7 days postadministration.
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Affiliation(s)
- Shobu Watanabe
- Department of Radiology, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan.
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Okada T, Yamaguchi M, Takahashi T, Izaki K, Uotani K, Sakamoto N, Sugimura K, Sugimoto K. Is Embolization of the Pancreas Safe? Pancreatic Histological Changes after Selective Transcatheter Arterial Embolization with N-Butyl Cyanoacrylate in a Swine Model. Cardiovasc Intervent Radiol 2011; 35:161-7. [DOI: 10.1007/s00270-011-0130-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 02/09/2011] [Indexed: 12/31/2022]
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Nagar N, Dubale N, Jagadeesh R, Nag P, Reddy ND, Rao G. Unusual locations of pseudo aneurysms as a sequel of chronic pancreatitis. JOURNAL OF INTERVENTIONAL GASTROENTEROLOGY 2011; 1:28-32. [PMID: 21686110 DOI: 10.4161/jig.1.1.14597] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Revised: 07/23/2010] [Accepted: 07/25/2010] [Indexed: 11/19/2022]
Abstract
In patients with chronic pancreatitis, an actively bleeding pseudo aneurysm can be life threatening. Common sites of pseudoaneurysms are splenic, gastro-duodenal, superior & inferior pancreaticoduodenal arterial branches. Angioembolisation is an effective alternative to a complex and morbid operative management. Here we report 4 cases of unusual sites of pseudoaneurysms as a complication of pancreatitis, involving superior mesenteric and inferior phrenic arteries. Successful angioembolisation using glue and coil was achieved in 3 patients where as one underwent surgery. Technical success was 100% with the combination approach, though one patient died from multiorgan failure. This short case series reiterates the importance of vascular complications in pancreatitis at rare sites and also timely combined radiological and surgical approach for ensuring favorable outcome.
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Skipworth J, Raptis D, Brennand D, Imber C, Shankar A. The management of multi-site, bleeding, visceral artery pseudoaneurysms, secondary to necrotising pancreatitis. Ann R Coll Surg Engl 2009; 91:255-8. [PMID: 19220939 DOI: 10.1308/003588409x359295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We present the case of a 45-year-old man, who presented to his local casualty department with severe epigastric pain following an alcohol binge, and was subsequently diagnosed with acute pancreatitis. Pancreatic necrosis with multiple collections ensued, necessitating transfer to an intensive care unit (ITU) in a tertiary hepatopancreaticobiliary centre. Initially, the patient appeared to slowly improve and was discharged to the ward, albeit following a prolonged ITU admission. However, during his subsequent recovery, he suffered multiple episodes of haematemesis and melaena associated with haemodynamic instability and requiring repeat admission to the ITU. Computerised tomographic angiography, followed by visceral angiography, was used to confirm the diagnosis of multisite visceral artery pseudoaneurysms, secondary to severe, necrotising pancreatitis. Pseudoaneurysms of the splenic, left colic and gastroduodenal arteries were sequentially, and successfully, radiologically embolised over a period of 9 days. Subsequent sequelae of radiological embolisation included a clinically insignificant splenic infarct, and a left colonic infarction associated with subsequent enterocutaneous fistula formation. The patient made a prolonged, but successful, recovery and was discharged from hospital after 260 days as an in-patient. This case illustrates the rare complication of three separate pseudoaneurysms, secondary to acute pancreatitis, successfully managed radiologically in the same patient. This case also highlights the necessity for multidisciplinary involvement in the management of pseudoaneurysms, an approach that is often most successfully achieved in a tertiary setting.
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Affiliation(s)
- J Skipworth
- Department of Hepatobiliary and Pancreatic Surgery, University College Hospital NHS Trust, London, UK.
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Left colic artery pseudoaneurysm from pancreatitis presenting as upper gastrointestinal hemorrhage. J Vasc Interv Radiol 2008; 20:133-6. [PMID: 19028114 DOI: 10.1016/j.jvir.2008.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 10/01/2008] [Accepted: 10/02/2008] [Indexed: 11/23/2022] Open
Abstract
Visceral pseudoaneurysms resulting from pancreatitis occur in approximately 10% of cases. The present report describes a left colic artery pseudoaneurysm from pancreatitis presenting with active duodenal bleeding. Based on the clinical and endoscopic demonstration of duodenal bleeding, celiac and superior mesenteric arteriograms were initially obtained, and their findings were negative. Repeat arteriography, including an inferior mesenteric artery injection, demonstrated a left colic pseudoaneurysm with rupture into the pancreatic duct and retrograde flow into the duodenum. Because of inconsistent diagnostic yields for arteriography performed for pancreatitis-related bleeding, the authors recommend disciplined interrogation of all three major mesenteric vessels, unbiased by initial endoscopic findings, to reduce false-negative examination results and empiric embolization.
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Kirby JM, Vora P, Midia M, Rawlinson J. Vascular complications of pancreatitis: imaging and intervention. Cardiovasc Intervent Radiol 2007; 31:957-70. [PMID: 17680304 DOI: 10.1007/s00270-007-9138-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 06/05/2007] [Accepted: 06/23/2007] [Indexed: 02/07/2023]
Abstract
The objective of this study was to highlight technical challenges and potential pitfalls of diagnostic imaging, intervention, and postintervention follow-up of vascular complications of pancreatitis. Diagnostic and interventional radiology imaging from patients with pancreatitis from 2002 to 2006 was reviewed. We conclude that biphasic CT is the diagnostic modality of choice. Catheter angiography may (still) be required to diagnose small pseudoaneurysms. Endovascular coiling is the treatment of choice for pseudoaneurysms. Close clinical follow-up is required, as patients may rebleed/develop aneurysms elsewhere.
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Affiliation(s)
- John M Kirby
- McMaster University Medical Center, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada.
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