Abstract No. 125 Endovascular versus percutaneous treatment of pancreatic pseudoaneurysms

Abstract

To compare outcomes after endovascular versus percutaneous treatment of pancreatic pseudoaneurysms The research subjects review board approved this retrospective cohort study. Angiograms performed between June 2013 through June 2019 were evaluated. In patients who underwent visceral angiography, a subset of patients with suspected pancreatic pseudoaneurysms were identified. Multiple factors were evaluated including age, hemodynamic status, grade of injury, initial imaging result, angiographic result, vessel embolized, embolic agent used, technical outcome and complication rates in the following 90 days. 17 unique visceral artery pseudoaneurysms were identified in 16 patients (7F). 16 pseudoaneurysms were secondary to chronic pancreatitis and one pseudoaneurysm was secondary to an abscess adjacent to the pancreatic tail after splenectomy. Six patients were treated with endovascular embolization. Four patients were treated with percutaneous embolization, of which three were treated with thrombin and one with a 50/50 mixture of n-BCA/lipiodol. Seven patients underwent no embolization. Technical success was 100% for both embolization techniques. When comparing endovascular versus percutaneous embolization there was no difference in average age (57.2 ± 13.9 years vs 53 ± 13.4 years) or volume of the active core measured on prior CT (30.6 mL ± 27.8cc vs 30 mL ± 30.2 cc). One of the patients in the percutaneous group had rebleeding, which was treated successfully with endovascular coiling. No patients treated with endovascular embolization had rebleeding. One patient treated with percutaneous embolization died 22 days after embolization due to respiratory failure. One patient died 13 days after endovascular embolization of uncertain etiology. Overall, mortality among treated patients was 20%. Mortality rate after interventional radiology treatment of pancreatic pseudoaneurysms was 20% in treated patients. This is lower than prior reported studies. Post treatment rate of rebleeding was 10% and did not result in increased mortality. Percutaneous treatment of pancreatic pseudoaneurysms had a higher rate of mortality and rebleeding than endovascular treatment.