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Khatri S, Parikh R, Smith M, Friedman J. Endovascular management of colic artery pseudoaneurysm: A case report of successful intervention in a 59-year-old male with abdominal hematoma. Radiol Case Rep 2024; 19:449-454. [PMID: 38046917 PMCID: PMC10692486 DOI: 10.1016/j.radcr.2023.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 12/05/2023] Open
Abstract
Visceral artery pseudoaneurysms, including inferior mesenteric artery pseudoaneurysms, are rare, occurring at an estimated incidence of 0.01%-0.2%. The literature reports only around 60 cases of inferior mesenteric pseudoaneurysm to date. The management of this condition lacks a consensus; nevertheless, coil embolization remains the preferred approach for stable patients. Here, we present a unique clinical scenario involving a 59-year-old male who underwent exploratory laparotomy for a retroperitoneal hematoma. Subsequently, he was diagnosed with an inferior mesenteric pseudoaneurysm, specifically affecting the left colic artery, and successfully managed using coil embolization.
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Affiliation(s)
| | | | - Matthew Smith
- Department of Radiology, Jamaica Hospital Medical Center, Queens, NY 11418, USA
| | - Joseph Friedman
- Department of Radiology, Jamaica Hospital Medical Center, Queens, NY 11418, USA
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2
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Zoghoul S, Al-Hashimi I, Aldebyani Q, Kassamali R, Omar A, Barah A. Accidental portal vein catheterization during pleural drainage catheter insertion: a case report. J Med Case Rep 2023; 17:552. [PMID: 38115036 PMCID: PMC10731741 DOI: 10.1186/s13256-023-04291-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Iatrogenic portal vein (PV) injuries following pleural drainage catheter (PDC) insertion are rare but life-threatening. This case report emphasizes the importance of prompt recognition and effective interventional radiology (IR) management. CASE PRESENTATION A 38-year-old Asian male, admitted for a non-ST-segment elevation myocardial infarction, suffered a critical PV injury during PDC insertion, leading to rapid clinical deterioration. The IR team conducted a portogram, retrieved the catheter, and successfully executed an embolization procedure. The patient's recovery, confirmed through imaging and improving liver function tests, enabled discharge with follow-up instructions. CONCLUSIONS This case highlights the clinical significance of promptly recognizing and effectively managing iatrogenic PV injuries during PDC insertion, with the pivotal role of IR. Collaboration between IR and surgical teams is crucial for optimizing patient outcomes.
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Affiliation(s)
- Sohaib Zoghoul
- Department of Radiology, Hamad Medical Corporation, Doha, Qatar
| | | | - Qayed Aldebyani
- Department of Radiology, Hamad Medical Corporation, Doha, Qatar
| | - Rahil Kassamali
- Department of Radiology, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Omar
- Department of Radiology, Hamad Medical Corporation, Doha, Qatar
| | - Ali Barah
- Department of Radiology, Hamad Medical Corporation, Doha, Qatar.
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3
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Rinaldi LF, Brioschi C, Marone EM. Endovascular and Open Surgical Treatment of Ruptured Splenic Artery Aneurysms: A Case Report and a Systematic Literature Review. J Clin Med 2023; 12:6085. [PMID: 37763025 PMCID: PMC10531855 DOI: 10.3390/jcm12186085] [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: 09/01/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Ruptured splenic artery aneurysms (r-SAA), although rare, are burdened by high morbidity and mortality, even despite emergent surgical repair. It is suggested that endovascular treatment can achieve reduction in peri-operative death and complication rates, as in other vascular diseases, but evidence of such benefits is still lacking in this particular setting. We report a case of an r-SAA treated by trans-arterial embolization and then converted to open surgery for persistent bleeding, and we provide a systematic review of current results of open and endovascular repair of r-SAAs. MATERIALS AND METHODS A 50-year-old male presenting in shock for a giant r-SAA underwent emergent coil embolization and recovered hemodynamic stability. On the following day, he underwent laparotomy for evacuation of the huge intraperitoneal hematoma, but residual bleeding was noted from the splenic artery, which was ligated after coil removal, and a splenectomy was performed. A systematic literature review of the reported mortality and complications of r-SAA undergoing open (OSR) or endovascular (EVT) treatment was performed using the main search databases. All primary examples of research published since 1990 were included regardless of sample size. The main outcome measures were mortality and reinterventions. Secondary outcomes were post-operative complications. RESULTS We selected 129 studies reporting on 350 patients-185 treated with OSR and 165 with EVT. Hemodynamically unstable patients and ruptures during pregnancy were more frequently treated with open repair. Overall, there were 37 deaths (mortality: 10.6%)-24 in the OSR group and 13 in the EVTr group (mortality: 12.9% and 7.8% respectively, p-value: 0.84). There were 37 reinterventions after failed or complicated endovascular repair -6 treated with endovascular re-embolization and 31 with laparotomy and splenectomy (22.4%); there were 3 (1.6%) reinterventions after open repair. Overall complication rates were 7.3% in the EVT group (n: 12) and 4.2% in the OSR group (n: 7), and did not require reintervention. No significant differences in overall complications or in any specific complication rate were observed between the two groups. CONCLUSIONS Current results of r-SAA treatment show equipoise terms of morbidity and mortality between open and endovascular repair; however, in case of hemodynamic instability and rupture during pregnancy, open surgery might still be safer. Moreover, endovascular repair is still burdened by a significantly higher rate of reinterventions, mostly with conversions to open surgery.
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Affiliation(s)
- Luigi Federico Rinaldi
- Vascular Surgery, Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, 16132 Genoa, Italy
- Vascular Surgery, Ospedale Policlinico di Monza, 20900 Monza, Italy; (C.B.); (E.M.M.)
| | - Chiara Brioschi
- Vascular Surgery, Ospedale Policlinico di Monza, 20900 Monza, Italy; (C.B.); (E.M.M.)
| | - Enrico Maria Marone
- Vascular Surgery, Ospedale Policlinico di Monza, 20900 Monza, Italy; (C.B.); (E.M.M.)
- Vascular Surgery, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
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Chong A, Ng SL, Danaher L. Gastroepiploic artery pseudoaneurysm: a rare cause of abdominal pain. ANZ J Surg 2019; 90:909-910. [PMID: 31512808 DOI: 10.1111/ans.15405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/22/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Aaron Chong
- Division of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Suat Li Ng
- Division of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Luke Danaher
- Mater Medical Imaging, Mater Hospital, Brisbane, Queensland, Australia
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5
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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: 9] [Impact Index Per Article: 1.5] [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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6
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Huang Q, Gao K, Zhai RY. Endovascular management of two episodes of late intraperitoneal hemorrhage following laparoscopic gastrectomy for gastric cancer. Mol Clin Oncol 2014; 2:549-552. [PMID: 24940493 DOI: 10.3892/mco.2014.288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 03/04/2014] [Indexed: 11/05/2022] Open
Abstract
Endovascular treatment for hemorrhagic complications following surgery has recently gained wide acceptance due to its minimal invasiveness compared to surgery. A 56-year-old male patient underwent laparoscopic gastrectomy for gastric cancer. There were two episodes of late intraperitoneal hemorrhage and endovascular treatment was performed. Transcatheter coil embolization of the gastroduodenal artery stump was successful in controlling the bleeding initially; however, hemorrhage recurred 7 days later. Repeated angiography revealed an obvious hemorrhage from the right gastric artery stump and embolization of the hepatic artery proper was performed to achieve immediate hemostasis. The endovascular treatment process was analyzed and the literature on similar situations was reviewed. In the present case, endovascular procedures were performed successfully to control bleeding in two episodes of late intraperitoneal hemorrhage. Angiography is recommended as the first-line modality for late intraperitoneal hemorrhage following laparoscopic gastrectomy and transcatheter coil embolization of the hepatic artery proper is safe and effective in selected cases.
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Affiliation(s)
- Qiang Huang
- Department of Interventional Radiology, Beijing Chaoyang Hospital, Capital Medical University, Chaoyang, Beijing 100020, P.R. China
| | - Kun Gao
- Department of Interventional Radiology, Beijing Chaoyang Hospital, Capital Medical University, Chaoyang, Beijing 100020, P.R. China
| | - Ren-You Zhai
- Department of Interventional Radiology, Beijing Chaoyang Hospital, Capital Medical University, Chaoyang, Beijing 100020, P.R. China
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Pseudoaneurisma intrarrenal secundario a nefrolitotomía percutánea: revisión de la literatura y reporte de un caso. UROLOGÍA COLOMBIANA 2014. [DOI: 10.1016/s0120-789x(14)50008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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8
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Miao YD, Ye B. Intragastric rupture of splenic artery aneurysms: Three case reports and literature review. Pak J Med Sci 2013. [PMID: 24353598 DOI: 10.12669/pjms.292.2992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Rupture of splenic artery aneurysm remains an uncommon cause of hypovolemic shock although it is the third most common intra-abdominal aneurysms. It is difficult to diagnosis timely and entails a significant morbidity and mortality. We present three uncommon cases of bleeding from upper gastrointestinal tract as a result of rupture of splenic artery aneurysm to stomach in patients with liver cirrhosis or infectious endocarditis. We also reviewed the literature and these case reports highlighted that rapid resuscitation, diagnostic imaging, surgical consultation, and alternatively transarterial embolization were the priorities in the management. Early diagnosis and intervention for ruptured splenic artery aneurysm are crucial for patient's survival; therefore, it must be kept in mind as feasible etiology of life-threatening gastrointestinal bleeding, especially in patients with underlying liver cirrhosis or infective endocarditis.
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Affiliation(s)
- Yang-de Miao
- Yang-de MIAO, Department of Gastroenterology, Taizhou Municipal Hospital, Taizhou 318000, Zhejiang, China
| | - Bei Ye
- Bei YE, Department of Gastroenterology, Taizhou Municipal Hospital, Taizhou 318000, Zhejiang, China
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9
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Künzle S, Glenck M, Puippe G, Schadde E, Mayer D, Pfammatter T. Stent-graft repairs of visceral and renal artery aneurysms are effective and result in long-term patency. J Vasc Interv Radiol 2013; 24:989-96. [PMID: 23727420 DOI: 10.1016/j.jvir.2013.03.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 03/14/2013] [Accepted: 03/20/2013] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To report on the long-term outcomes of endovascular exclusion of visceral and renal artery aneurysms with the use of stent-grafts. MATERIALS AND METHODS Nineteen consecutive patients (mean age, 59 y ± 16 [standard deviation]) with a total of 19 visceral artery aneurysms (VAAs; hepatic, n = 6; celiac, n = 4; renal, n = 4; splenic, n = 3; and superior mesenteric, n = 2) were electively (n = 9) or emergently (n = 10) treated with a variety of stent-grafts. The etiology of aneurysms was variable: postoperative (n = 9), infectious (n = 3), idiopathic (n = 4), Ehlers-Danlos syndrome (n = 2), and α1-antitrypsin deficiency (n = 1). The patients were followed up with clinical examinations and computed tomographic (CT) angiography. RESULTS No patient was lost to follow-up. The in-hospital mortality rate was 11% (n = 2). Three patients died of cancer after successful VAA treatment. At the last follow-up, the remaining 14 patients were alive and well. Three patients refused follow-up CT angiography. CT angiography demonstrated stent-graft patency at a mean follow-up of 28 months (range, 2-100 mo) in nine of 11 remaining patients (82%) and thrombosis in two patients (one with a splenic and one with a renal artery stent-graft). These events were asymptomatic. All aneurysms decreased in size. Late repeat intervention was performed to treat a celiac restenosis in a patient with a hepatic stent-graft. CONCLUSIONS Irrespective of their etiology and acuteness, VAAs can be treated with stent-grafts, with an excellent clinical long-term outcome and a high patency rate.
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Affiliation(s)
- Stefan Künzle
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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10
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Ramalingam V, Kabutey NK, Vilvendhan R, Kim D. Endovascular management of anastomotic blowout of proper hepatic to common hepatic artery saphenous vein bypass with coil embolization and hepatic artery stent placement. Vasc Endovascular Surg 2013; 47:310-3. [PMID: 23471199 DOI: 10.1177/1538574413481116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mesenteric and visceral artery pseudoaneurysms in the abdomen are a relatively rare complication after abdominal surgery. It is a complication primarily associated with pancreatic and hepatobiliary surgery, trauma, iatrogenic causes and inflammatory diseases. Regardless of etiology, visceral artery pseudoaneurysms of the abdomen reportedly occur only in 0.01% to 2% of the population. Although rare, these are associated with life-threatening bleeding complications and need to be appropriately managed. We present the case of a patient who presented with bleeding after developing a pseudoaneurysm at the distal anastomotic site of a common hepatic to proper hepatic artery interposition saphenous vein bypass that was subsequently excluded by coil embolization and stent graft placement.
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11
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Vulev I, Klepanec A, Madaric J, Tomka J, Sefranek V. Endovascular treatment of a giant aorto-ostial renal artery pseudoaneurysm. Ann Vasc Surg 2011; 25:1140.e13-6. [PMID: 21835587 DOI: 10.1016/j.avsg.2011.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 03/18/2011] [Accepted: 04/04/2011] [Indexed: 11/28/2022]
Abstract
Vascular complications after lumbar laminectomy are rare, but are potentially life-threatening. A 59-year-old man presented with progressive and worsening abdominal pain over several weeks. Multidetector computed tomography angiography revealed a large aorto-ostial left renal artery pseudoaneurysm 3 years after lumbar laminectomy. The pseudoaneurysm was successfully treated with a combination of various endovascular techniques ("jailed" microcatheter technique, stent-graft implantation, thrombin injection, balloon remodeling technique, Onyx application), with preserved patency of the left renal artery and pseudoaneurysm exclusion on 6-month follow-up multidetector computed tomography angiography. The size and location of this pseudoaneurysm and the combination of different techniques for endovascular treatment provides an update on current endovascular technology. Combination of different endovascular techniques can be a safe and feasible alternative for the treatment of complicated iatrogenic postlaminectomy vascular injuries and renal artery pseudoaneurysms.
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Affiliation(s)
- Ivan Vulev
- Department of Diagnostic and Interventional Radiology, National Institute of Cardiovascular Diseases, Bratislava, Slovakia.
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12
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Giulianotti PC, Buchs NC, Coratti A, Sbrana F, Lombardi A, Felicioni L, Bianco FM, Addeo P. Robot-Assisted Treatment of Splenic Artery Aneurysms. Ann Vasc Surg 2011; 25:377-83. [DOI: 10.1016/j.avsg.2010.09.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 06/08/2010] [Accepted: 09/26/2010] [Indexed: 01/17/2023]
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13
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Herzog T, Suelberg D, Belyaev O, Uhl W, Seemann M, Seelig MH. Treatment of acute delayed visceral hemorrhage after pancreatic surgery from hepatic arteries with covered stents. J Gastrointest Surg 2011; 15:496-502. [PMID: 21240640 DOI: 10.1007/s11605-010-1260-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 06/07/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND Delayed visceral hemorrhage following pancreatic surgery is a rare but life-threatening complication. Usually hemorrhage originates from pseudoaneurysms secondary to pancreatic or biliary fistula. Re-laparotomy is often associated with high morbidity and mortality. Endovascular occlusion with metallic coils can stop pseudoaneurysmatic bleeding, but hepatic artery occlusion can result in severe organ damage. Interventional treatment with covered stents is an alternative providing persistent organ perfusion. RESULTS In our department endovascular stenting for visceral hemorrhage was introduced in November 2008. From November 2008 until October 2009, 303 patients underwent pancreatic surgery at our institution. Among those, four patients were successfully treated with covered stents for delayed visceral hemorrhage. In all four patients bleeding originated from hepatic arteries. Mean onset of hemorrhage was 24 days after surgery. Endovascular stenting was successful in all four patients. None of these patients required re-operation or died during the study. CONCLUSION Treatment of delayed visceral hemorrhage from hepatic arteries after pancreatic surgery with covered stents is safe and effective. Endovascular stenting is associated with a lower morbidity than re-laparotomy or coil embolisation. Emergency angiography with endovascular stenting should be considered for all patients with delayed hemorrhage from hepatic arteries after pancreatic surgery.
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Affiliation(s)
- Torsten Herzog
- Department of Surgery, St. Josef Hospital, Ruhr-University of Bochum, School of Medicine, Bochum, Germany
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Philippou P, Moraitis K, El-Husseiny T, Wazait H, Masood J, Buchholz N. Endovascular covered stenting for the management of post-percutaneous nephrolithotomy renal pseudoaneurysm: a case report. J Med Case Rep 2010; 4:316. [PMID: 20863388 PMCID: PMC2955059 DOI: 10.1186/1752-1947-4-316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 09/23/2010] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Intrarenal pseudoaneurysm is a rare, yet clinically significant, complication of percutaneous nephrolithotomy. A high index of clinical suspicion is necessary in order to recognize pseudoaneurysm as the cause of delayed bleeding after percutaneous nephrolithotomy and angiography confirms the diagnosis which allows endovascular management. CASE PRESENTATION We present a case of a 65-year old Caucasian woman who underwent percutaneous nephrolithotomy in the supine position for a two centimetre renal calculus. The postoperative course was complicated by persistent bleeding due to a renal pseudoaneurysm. The vascular lesion was successfully managed by endovascular exclusion through the use of a covered stent graft. We report the first successful use of this method for the management of iatrogenic pseudoaneurysm in a branch of the left renal artery and we focus on the imaging findings, technical details, advantages and limitations of this technique. CONCLUSION As a result of its high efficacy, interventional radiology has largely replaced open surgery for the management of renal pseudoaneurysm related to percutaneous nephrolithotomy. Recent technical advancements have allowed the use of covered stent grafts as an alternative to embolisation for the angiographic management of visceral artery pseudoaneurysm located in other organs. This novel technique allows the endovascular exclusion of the pseudoaneurysm, without compromising arterial supply to the end-structures - an advantage of critical importance in organs supplied by segmental arteries - in the absence of collateral vasculature, such as the kidney.
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Affiliation(s)
- Prodromos Philippou
- Department of Urology, Barts and The London NHS Trust, Smithfield, London EC1A 7BE, UK
| | - Konstantinos Moraitis
- Department of Urology, Barts and The London NHS Trust, Smithfield, London EC1A 7BE, UK
| | - Tamer El-Husseiny
- Department of Urology, Barts and The London NHS Trust, Smithfield, London EC1A 7BE, UK
| | - Hassan Wazait
- Department of Urology, Barts and The London NHS Trust, Smithfield, London EC1A 7BE, UK
| | - Junaid Masood
- Department of Urology, Barts and The London NHS Trust, Smithfield, London EC1A 7BE, UK
| | - Noor Buchholz
- Department of Urology, Barts and The London NHS Trust, Smithfield, London EC1A 7BE, UK
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Schoppe KA, Ciacci J, Bettmann M. Modified stent-supported coil embolization for treatment of a splenic artery pseudoaneurysm. J Vasc Interv Radiol 2010; 21:1452-6. [PMID: 20691607 DOI: 10.1016/j.jvir.2010.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 02/16/2010] [Accepted: 04/29/2010] [Indexed: 10/19/2022] Open
Abstract
A patient presented 2 weeks after distal pancreatectomy and splenectomy with increased bloody output from his surgical drain. Catheter angiography found an enlarging splenic artery stump pseudoaneurysm. During the procedure, there was concern that nontarget embolization may occur, given the short splenic artery remnant. Pseudoaneurysm thrombosis was subsequently achieved using a variation of stent-supported coil embolization. At 3-month follow-up, the patient had no recurrent bleeding from the surgical site. Although this technique has been described in the treatment of neurovascular and renal artery aneurysms, it is applicable to, and readily adapted for, use in visceral arterial procedures.
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Affiliation(s)
- Kurt A Schoppe
- Department of Radiology, Division of Radiological Sciences, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston Salem, NC 27157, USA.
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Wang MQ, Liu FY, Duan F, Wang ZJ, Song P, Fan QS. Stent-grafts placement for treatment of massive hemorrhage from ruptured hepatic artery after pancreaticoduodenectomy. World J Gastroenterol 2010; 16:3716-22. [PMID: 20677346 PMCID: PMC2915434 DOI: 10.3748/wjg.v16.i29.3716] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To present a series of cases with life-threatening hemorrhage from ruptured hepatic artery pseudoaneurysm after pancreaticoduodenectomy (PD) treated with placement of stent-grafts.
METHODS: Massive hemorrhage from ruptured hepatic artery pseudoaneurysm after PD in 9 patients (6 men, 3 women) at the age of 23-75 years (mean 48 years), were treated with placement of percutaneous endovascular balloon-expandable coronary stent-grafts. All patients were not suitable for embolization because of a non-patent portal vein. One or more stent-grafts, ranging 3-6 mm in diameter and 16-55 mm in length, were placed to exclude ruptured pseudoaneurysm. Follow-up data, including clinical condition, liver function tests, and Doppler ultrasound examination, were recorded at the outpatient clinic.
RESULTS: Immediate technical success was achieved in all the 9 patients. All stent-grafts were deployed in the intended position for immediate cessation of bleeding and preservation of satisfactory hepatic arterial blood flow. No significant procedure-related complications occurred. Recurrent bleeding occurred in 2 patients at 16 and 24 h, respectively, after placement of stent-grafts and treated with surgical revision. One patient died of sepsis 12 d after the interventional procedure. The remaining 6 patients were survived when they were discharged. The mean follow-up time was 10.5 mo (range 4-16 mo). No patient had recurrent bleeding after discharge. Doppler ultrasound examination verified the patency of hepatic artery and stent-grafts during the follow-up.
CONCLUSION: Placement of stent-grafts is an effective and safe procedure for acute life-threatening hemorrhage from ruptured hepatic artery pseudoaneurysm.
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