Successful arterial embolization of a giant pseudoaneurysm of the gastroduodenal artery secondary to chronic pancreatitis with literature review

Gastroduodenal artery aneurysm/ pseudoaneurysm: a systematic review of reported cases

Background

This systematic review and meta-analysis investigated the clinical characteristics of patients with gastroduodenal artery aneurysm (GDA), identified risk factors associated with poor clinical outcomes, and elucidated potential differences between various GDA etiologies.

Methods

A systematic literature search was conducted from January 2000 to October 2023 in the PubMed, EMBASE, and Google Scholar databases. The analysis focused on extracting data regarding clinical presentations, diagnostic modalities, and patient outcomes.

Results

This meta-analysis included data from 224 patients derived from 207 case reports spanning 47 countries over a 23-year period. The majority of patients presented with comorbidity (85.3%) and had a predisposing factor for GDA (71.9%). The diagnostic accuracy of the three most common diagnostic investigations-namely angiography, abdominal computed tomography, and ultrasound-was 100.0%, 86.2%, and 59.6%, respectively. Transarterial embolization (75.0%) and surgery (24.1%) were the two most common therapeutic approaches. Emergent treatment for GDA was necessary in 31.7% of patients. Notably, hemostasis was achieved after the initial treatment attempt in 82.6% of patients. The in-hospital mortality rate was 6.7%, with complications occurring in 16.1% of cases. A higher percentage of patients with a complicated hospital course were subjected to observation management and presented with shock during hospitalization.

Conclusions

Patients with GDA often have comorbidities and predisposing factors. Clinical presentations of GDA were found to include abdominal pain, hemorrhage, and obstruction of peripheral structures in the vicinity of the gastroduodenal artery. Splanchnic artery angiography and abdominal computed tomography are recognized as the most accurate tools for diagnosing GDA. Endovascular management is the mainstay treatment approach for most patients and have a high rate of hemostasis success during the initial intervention. Surgical intervention is also a practical treatment. Conservative management with observation management may lead to a complicated hospital course, highlighting the potential benefit of aggressive treatment strategies for GDA. Patients with pancreatitis exhibited more comorbidities, predisposing factors, and a broader spectrum of clinical manifestations compared to those without pancreatitis. However, the in-hospital mortality rate was lower in the pancreatitis group, likely due to the younger age of the patients and the more prominent clinical presentations, which prompted earlier and more extensive diagnostic imaging studies.

Case report: Duodenal obstruction caused by gastroduodenal artery pseudoaneurysm with hematoma: an unusual case and literature review

Visceral artery pseudoaneurysm is a rare disease that most commonly occurs in male patients in their 50s, with gastroduodenal artery (GDA) pseudoaneurysm accounting for only 1.5% of these. The treatment options generally include open surgery and endovascular treatment. In 40 cases of GDA pseudoaneurysm from 2001 to 2022, endovascular therapy was the mainstay of treatment in 30 cases, and most of them (77%) were treated by coil embolization. Our case report describes a 76-year-old female patient with a GDA pseudoaneurysm, which was treated by endovascular embolization using liquid embolic agent N-butyl-2-cyanoacrylate (NBCA) alone. This is the first time this treatment strategy has been used for GDA pseudoaneurysm. We demonstrate a successful outcome with this unique treatment. The successful experience of our case may provide a new treatment strategy for this rare disease.

False in Name Only-Gastroduodenal Artery Pseudoaneurysm in a Recurrently Bleeding Patient: Case Report and Literature Review

Although the diagnosis of visceral pseudoaneurysm is unusual, it requires emergent attention due to the risk of rupture. We describe a 70-year-old man with a gastroduodenal artery pseudoaneurysm that manifested as recurrent hemorrhage. We highlight the possible etiologies, clinical presentations, diagnostic tools, and treatment options for this condition. In this instance, the patient was successfully treated by selective angioembolization. A visceral pseudoaneurysm should be considered in patients with abdominal pain and GI hemorrhage. At present, angioembolization is a first-line therapy.