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Abstract
ObjectivesTo present the various techniques used in the management of pancreatitis-related pseudoaneurysms of visceral vessels.MethodsThe retrospective clinical study was carried out at the Department of Diagnostic and Interventional Radiology at Poznan University of Medical Sciences from 2011 to 2016. The fifteen patients included in the study were diagnosed with pseudoaneurysms of visceral arteries, as a complication of chronic pancreatitis. The diagnosis was made using contrast-enhanced computed tomography, followed by angiography. On admission, all patients were symptomatic, with varying degrees of abdominal pain. One patient was haemodynamically unstable. Treatments with endovascular techniques were analysed, along with their efficacy and outcomes. Coil embolisation was performed in 5 patients. Stent graft was used in 1 patient. Liquid embolic agents were used in 7 cases, of which 5 patients were treated with thrombin injection and 2 with Squid. A combination of techniques was used in 2 patients.ResultsThe most common artery affected by pseudoaneurysm formation was the splenic artery (7/15; 46.7%), and the size of the pseudoaneurysms ranged from 27 mm to 85 mm. Primary technical success was achieved in 14 out of 15 patients (93.3%). One patient required reintervention. Two patients required splenectomy after embolisation due to splenic ischemia. No recanalisation was present at the follow-up computed tomography performed after 1 to 3 weeks, and no mortality was observed within 30 days.ConclusionVascular complications of pancreatitis require accurate diagnosis and immediate treatment. Endovascular intervention is highly effective and is the preferred treatment option. The technique used is determined based on vascular anatomy and the patient’s haemodynamic status.
Highlights
Following pancreatic inflammation, the spread of proteolytic fluids, causing weakening of local vessel walls, may lead to the formation of arterial pseudoaneurysms
The most common artery affected by pseudoaneurysm formation was the splenic artery (7/ 15; 46.7%), and the size of the pseudoaneurysms ranged from 27 mm to 85 mm
Endovascular management of pancreatitis-related pseudoaneurysms technique used is determined based on vascular anatomy and the patient’s haemodynamic status
Summary
The spread of proteolytic fluids, causing weakening of local vessel walls, may lead to the formation of arterial pseudoaneurysms. The formation of pseudoaneurysms occurs with a higher incidence in chronic pancreatitis (4% - 8%) than in acute pancreatitis (accurate prevalence not clearly defined in recent literature) [1,2,3]. Pseudoaneurysms most commonly affect the splenic artery, followed by gastroduodenal, pancreaticoduodenal, gastric, and hepatic arteries [4]. Regardless of their size, pseudoaneurysms present with a significant risk of spontaneous rupture and fatal haemorrhages, accompanied by a mortality rate reported to approach 100% [5, 6]. This study presents and analyses the different endovascular techniques used in the management of 15 patients with pseudoaneurysms arising as a complication of chronic pancreatitis
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