Pseudoaneurysm In Patient Research Articles

Successful stent for a pseudoaneurysm after the patent ductus arteriosus closure procedure

We describe the case of a large pseudoaneurysm after transcatheter closure of patent ductus arteriosus in a 42-year old male who developed back pain and dyspnoea 6 months subsequent to the first procedure. The patient's pseudoaneurysm was successfully treated using Talent prostheses (Medtronic AVE, Santa Rosa, CA, USA), though the postoperative course was without incident.

Diagnosis and treatment of traumatic optic neuropathy with carotid artery cavernous segment pseudoaneurysm

To summarize our experience in diagnosis of carotid cavernous segment pseudoaneurysm in patients with traumatic optic neuropathy, and to make recommendations for treatment. Retrospective study. Clinical data of 133 cases with traumatic optic neuropathy (TON) were reviewed. The diagnosis and treatment of four cases with carotid cavernous segment pseudoaneurysm (PSA) were analyzed. The incidence of traumatic optic neuropathy with pseudoaneurysm for this group of patients was 3.01% (4/133). Preliminary screening was performed with vascular-enhanced computed tomography (CT) scan, and was further confirmed by digital subtraction angiography (DSA). Among the four cases with pseudoaneurysm, three cases were successfully treated with vascular embolization. In one of the three cases, coil embolization was employed; and in the other two cases stent embolization was performed. The pseudoaneurysm disappeared after embolization, and nosebleeds subsided without significant complications. All four patients did not undergo nasal endoscopic optic nerve decompression. There was no recurrence of nose bleeding after embolization in the following 1 to 12 months, and in one case the patient's vision improved from no light perception to perceiving hand movement. There is a possibility of fatal epistaxis for traumatic optic neuropathy with carotid artery cavernous segment pseudoaneurysm. Endoscopic optic nerve decompression treatment (EOND) is not suitable for these cases; instead, it is recommended that patients with traumatic optic neuropathy go through vascular-enhanced computed tomography screening. Suspected cases should be diagnosed by digital subtraction angiography and be treated by embolization in a timely manner, with stent vascular interventional embolization being the ideal choice.

Pseudoaneurysm of the ascending aorta 31 years after mitral valve replacement

We describe a rare case of an ascending aortic pseudoaneurysm 31 years after mitral valve replacement with a Björk-Shiley mechanical valve. The aneurysm presumably expanded gradually during the years following surgery. As the valve was functioning normally, it was left in situ while the ascending aorta was replaced. This report provides valuable information regarding the long-term nature of this patient's pseudoaneurysm, and the long-term durability of the Björk-Shiley spherical valve in the mitral position.

Postpartum Hemorrhage Resulting from Pelvic Pseudoaneurysm: A Retrospective Analysis of 588 Consecutive Cases Treated by Arterial Embolization

This study was designed to determine the incidence of arterial pseudoaneurysm in patients presenting with postpartum hemorrhage (PPH), to analyze the angiographic characteristics of pseudoaneurysms that cause PPH, and to evaluate the effectiveness of pelvic arterial embolization for the treatment of this condition. Eighteen women with pelvic arterial pseudoaneurysm were retrieved from a series of 588 consecutive patients with PPH treated by arterial embolization. Clinical files, angiographic examinations, and procedure details were reviewed. The incidence of pseudoaneurysm was 3.06 % (18/588; 95 % confidence interval (CI): 1.82-4.8 %). A total of 20 pseudoaneurysms were found; 15/20 (75 %) were located on the uterine arteries. Angiography revealed extravasation of contrast material from pseudoaneurysm indicating rupture in 9 of 18 (50 %) patients. Arterial embolization was performed using gelatin sponge alone in 12 of 18 (67 %) patients or in association with metallic coils in 5 of 18 (28 %) patients or n-butyl-2-cyanoacrylate in 1 of 18 (6 %) patients. Arterial embolization allowed controlling the bleeding in all patients after one or two embolization sessions in 17 of 18 (94 %) and 1 of 18 patients (6 %) respectively, without complications, obviating the need for further surgery. Pseudoaneurysm is rarely associated with PPH. Arterial embolization is an effective and safe procedure for the treatment of PPH due to uterine or vaginal artery pseudoaneurysm. Our results suggest that gelatin sponge is effective for the treatment of ruptured pseudoaneurysms, although we agree that our series does not contain sufficient material to allow drawing definitive conclusions with respect to the most effective embolic material.

A Large Left Ventricular Diverticulum in a Patient With Congenital Pulmonic Stenosis

A 56-year-old asymptomatic white woman underwent transthoracic echocardiography. She had a history of moderate to severe congenital pulmonic stenosis for which she underwent surgical valvotomy at age 14 years. The echocardiogram showed a normal transpulmonic pressure gradient. From the apical 4-chamber view of the contrast-enhanced echocardiogram, the left ventricle had a “bifurcating” or “mirror image” appearance with a large outpouching laterally (Fig. 1A, arrows). This outpouching structure had a wide neck, normal contractility, and near-complete emptying (Fig. 1B, end systole). Cardiac magnetic resonance imaging (MRI) was performed to further characterize this unusual structure. The cardiac MRI axial 4-chamber view demonstrated a large (4.7 cm) anterolateral left ventricular (LV) diverticulum with normal contractility (Fig. 1C, end-diastole; Fig. 1D, endsystole; Video 1 , view video online). The cardiac MRI short-axis view from the base to the apex revealed prominent trabeculation (Fig. 1, E-G; Video 2 , view video online). No mural thrombus was seen. The LV ejection fraction was 56%. Delayed enhanced images showed no scar. Before her previous pulmonic valve surgery, left ventriculography was performed in the anterior-posterior view, which could have missed this laterally located diverticulum. Congenital LV diverticulum is a rare malformation. LV diverticulum with concomitant congenital pulmonic stenosis is extremely rare. LV diverticula should be differentiated from LV aneurysms or pseudoaneurysms in patients with history of cardiac surgery or adults at risk for atherosclerotic

Peripheral arterial involvement in Behcet’s disease: an analysis of the results from a Korean referral center

The purposes of this study are to review the results of endovascular and surgical interventions and to evaluate clinical appearances of recurrent arterial involvement in patients with peripheral arterial Behçet disease (BD). A total of 28 patients with peripheral arterial BD were identified. There were 24 males (85.7%), with mean age of 40.0 ± 9.0 years (range 21-59). Arterial involvements were confirmed with computed tomography angiography, magnetic resonance image angiography, or ultrasound. Immunosuppressive agents were administrated to all patients. Indications of intervention were acute symptoms due to arterial occlusion and aneurysmal changes with or without rupture. Among 28 patients with peripheral arterial BD, 10 endovascular and 24 surgical interventions were performed in 21 patients. All 21 patients who underwent endovascular and surgical intervention were followed up for a mean duration of 78.7 ± 52.5 months (range 0-182 months). There was one mortality due to the rupture of pseudoaneurysm in patient who underwent stent-graft insertion for abdominal aortic aneurysm. New arterial involvements of BD occurred in 10 patients. All patients were male, and median age was 33.5 years (range 29-59 years). Mean time of onset of the new arterial lesion was 32.7 ± 32.1 months. In conclusion, the result of endovascular and surgical interventions is satisfactory in patients with acute peripheral arterial BD. Accurate diagnosis with immunosuppressive therapy is mandatory to prevent recurrence and activation of peripheral arterial BD.

Unexplained occurrence of multiple de novo pseudoaneurysms in patients with chronic kidney disease undergoing angioembolization for bleeding following percutaneous renal intervention: Are we dealing with infection or vasculitis?

Background and Objectives:Patients with chronic kidney disease (CKD) are more prone for bleeding following percutaneous renal intervention, as compared to those with normal renal function. Causes are multi-factorial. Finding multiple aneurysms away from the site of renal intervention following initial angioembolization for hemorrhage is very unusual in these patients.Materials and Methods:Clinical and radiological findings of all the patients who underwent renal angiography for post-intervention bleed for a period of 5 years were reviewed and analyzed.Results:A total of 29 patients required angiography for post-intervention hemorrhage. Six patients had recurrence of hemorrhage for which they underwent repeat angiography. Four of these patients had appearance of multiple new aneurysms away from the site of percutaneous nephrostomy (PCN)/percutaneous nephrolithotomy (PNL) puncture and the site of previous bleeding. All the patients had CKD (creatinine >2.5 mg/dl). They were on prolonged preoperative urinary diversion and had polymicrobial urinary infection. Three patients had candiduria. None of these patients had re-bleeding after repeat embolization and treatment with antibacterial and antifungal agents.Conclusions:Development of multiple aneurysms away from the sites of punctures in patients with CKD following percutaneous intervention is very unusual. Its causation including infection with bacteria and fungus, reaction of embolizing material, and angiopathy needs to be explored.

Pseudoaneurysm of the Inferior Phrenic Artery Presenting as an Upper Gastrointestinal Bleed by Directly Rupturing Into the Stomach in a Patient With Chronic Pancreatitis

Pseudoaneurysms occurring in patients with chronic pancreatitis are associated with significant morbidity and mortality. These pseudoaneurysms occur more commonly in the splenic, pancreaticoduodenal, and gastroduodenal arteries. Upper gastrointestinal bleeding (UGIB) due to pseudoaneurysms in patients with pancreatitis with pseudocyst usually presents as hemosuccus pancreaticus. However, pseudoaneurysm directly perforating the gastrointestinal tract and presenting as UGIB is a rare complication. We report here the first case of UGIB from the inferior left phrenic artery pseudoaneurysm rupturing directly into the stomach of a patient with chronic pancreatitis.

Simple ligation versus arterial revascularisation of femoral pseudo aneurysms in intravenous drug users; a systematic review

Simple ligation versus arterial revascularisation of femoral pseudo aneurysms in intravenous drug users; a systematic review

With computed tomography confirmed anterolateral left ventricular pseudoaneurysm in patient with dilatative alcoholic cardiomyopathy

BackgroundPseudoaneurysms are rare complications of myocardial infarction with propensity for rupture. There is still a challenge with which diagnostic imaging we performed a final diagnosis of pseudoaneurysm and differentiate it from true aneurysm what is clinically important due to the different treatment.Case report.We presented the unusual case of a 56-year-old man with signs of decompensated heart failure which had worsened a few months before hospitalization. We believed that during worsening of symptoms the patient suffered a silent myocardial infarction complicated by subacute free wall rupture which resulted into left ventricular pseudoaneurysm formation without tamponade. Echocardiography showed dilatative cardiomyopathy which was already present years before and a very rare location of the left ventricular pseudoaneurysm on the anterolateral part of the left ventricle. Pseudoaneurysm was confirmed with CT scan. Due to the severity of contractile dysfunction and no response in treatment for congestive heart failure the directive for the resection was tempered and the patient died due to the progressive heart failure and embolic phenomena.ConclusionsThis report shows the importance of non-invasive imaging diagnostic evaluation of acute decompensated heart failure where echocardiography and chest X-ray are the first diagnostic steps. Based on those findings further imaging diagnostic steps must be performed such as CT scan in our case which finally confirms left ventricular pseudoaneurysm with dilatative cardiomyopathy.

Invited Commentary

The treatment pendulum is swinging in many areas of aortic surgery away from open repair toward a less invasive approach using endovascular technologies. However, the current study by Dr Malvindi and colleagues [1Malvindi P.G. van Putte B.P. Heijmen R.H. Schepens M.A.A.M. Morshuis W.J. Reoperations for aortic false aneurysms after cardiac surgery.Ann Thorac Surg. 2010; 90: 1437-1443Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar] demonstrates with regards to the complex subject of reoperation for aortic pseudoaneurysms after prior cardiac operations that open surgical repair remains the most prudent and successful approach. Several factors lead to the development of aortic pseudoaneurysms in patients with a history of cardiac operations; however, it appears that it is becoming a more frequent diagnosis. This study describes 43 cases of aortic pseudoaneurysm in patients with prior cardiac operations over a 14-year period. Many of these patients were asymptomatic at the time of diagnosis, which demonstrates the clinical need for regular computed tomography screening in any patient with a previous aortic operation. In addition, with more high-resolution computed tomography scans being performed, various other focal aortic defects are being identified that may require the same surgical treatment principles as described in their article. One of the most critical aspects of this type of surgical repair is the management of cardiopulmonary bypass cannulation to most safely reenter the chest. Before the chest was opened, 14 patients in this series had initiation of cardiopulmonary bypass and 5 patients in this series needed hypothermic circulatory arrest due to adherence of the aortic pseudoaneurysm to the posterior aspect of the sternum. The authors use the criteria of less than 2 cm of distance between the sternum and the aortic aneurysm on preoperative imaging on when to pursue this approach. Certainly, the excellent outcomes described in this article are directly related to the success of this algorithm. The final important surgical principle that their article highlights is the need for extensive debridement of the pseudoaneurysm and surrounding aortic tissue. One-third of the pseudoaneurysms were related to infection, and 70% of the patient cohort received an aortic graft replacement. Without aggressive repair, these lesions may recur or achieve an inadequate resection. As the authors correctly discuss, endovascular techniques, including hybrid repair, have been described for the treatment of this problem. However, with the excellent surgical outcomes listed in this article, it is difficult to deny patients an open surgical resection. Some patients at high surgical risk may benefit from the less invasive approach, but all of the patients in this study were undergoing redo procedures and had many medical comorbidities. In addition, many of the lesions described in this report were in an unfavorable location for an endovascular approach. Until endovascular technologies advance significantly, an open surgical repair using the principles and techniques listed in this article for aortic pseudoaneurysms in patients with prior cardiac operations should be considered the definitive approach. Reoperations for Aortic False Aneurysms After Cardiac SurgeryThe Annals of Thoracic SurgeryVol. 90Issue 5PreviewAortic false aneurysm is a rare complication after cardiac surgery. Aortic dissection, infection, arterial wall degeneration, and poor surgical technique are recognized as risk factors for the occurrence of postsurgical false aneurysm. Despite some recent reports about percutaneous false aneurysm exclusion, a complex surgical reoperation is needed in most of the cases. Full-Text PDF

Formation of Pseudoaneurysm after Aortic Valve Replacement without Previous Endocarditis: A Case-Control Study

The aim of this study was to identify the predisposing factors for pseudoaneurysm formation after aortic valve replacement without previous endocarditis. Echocardiography was used to identify patients. Parameters with influence on the occurrence of pseudoaneurysms were analyzed, and the odds ratio for the influence of the type of valve was estimated. The chi2 goodness-of-fit test was used to analyze whether location or underlying etiology was associated with an accumulated occurrence of a pseudoaneurysm. Fisher's exact test was used to assess a possible relation between the occurrence of a pseudoaneurysm after composite graft implantation and etiology or location. Patients treated with composite grafts had a 27-fold increased risk for developing pseudoaneurysms (psiMH=27; 95% confidence interval, 1.61-454.19) in comparison with aortic valve replacement only. There was a significant difference for the probability of different etiologies to occur (P=.032), with Stanford type A aortic dissection and aortic regurgitation being the most often occurring pathologies. Significant associations between the use of a composite graft and both the underlying etiology (P=.002) and the location of the pseudoaneurysm (P=.04) was found. Furthermore, patients with composite grafts had larger diameters of the aortic root compared with patients with aortic valve replacement only (P=.03). Neither the diameter of the annulus of the aortic valve (95% confidence interval, 0.89-1.32; P=.41) nor the diameter of the ascending aorta (95% confidence interval, 0.27-1.97; P=.54) had any influence on pseudoaneurysm formation. The underlying disorder, determining the surgical procedure, influences the risk for the development of pseudoaneurysms in patients without previous endocarditis. The location of most pseudoaneurysms at the level of the aortic root may be a consequence of its larger diameter.

Endovascular treatment of aortic pseudoaneurysm in Behçet disease

This study evaluated the feasibility, efficacy, and outcome of endovascular therapy combined with immunosuppressive therapy for aortic pseudoaneurysms in patients with Behçet disease. Between April 2002 and April 2008, 12 pseudoaneurysms (9 involving the intrarenal abdominal aorta, 1 at the suprarenal level, and 2 in the supraceliac aorta) in nine men and one woman with Behçet disease were evaluated at Peking Union Medical Center (PUMC). Three bifurcated stent grafts and seven tubular stent grafts, including two fenestrated stent grafts, were deployed. All 10 patients received immunosuppressive therapy after the implant procedure. All patients underwent successful endovascular therapy without major complications during the 30 days immediately after the procedure. One patient with two aneurysms had treatment of only the larger infrarenal symptomatic aneurysm, but the smaller suprarenal pseudoaneurysm was not addressed because of its proximity to mesenteric branches. During a mean follow-up of 25.8 months (range, 6-50 months), nine aneurysms resolved completely in eight patients. The only untreated aneurysm, which coexisted with a treated lesion, remained stable under imaging observation. Three aneurysms recurred in two patients. At 6 months, one patient presented with a new aneurysm at the femoral artery access site for stent graft introduction and another formed at the proximal margin of the stent graft. Despite medical advice, he had stopped immunotherapy. He died from aneurysm rupture 8 months after stent deployment. Another patient with recurrent aneurysmal disease at the distal margin of the primary stent was successfully treated with an additional stent graft. These two were the only patients who did not adhere to taking immunosuppressant medicine after discharge. Endovascular stent graft placement combined with immunosuppressive treatment for aortic pseudoaneurysms in Behçet disease is a feasible and effective management option. Long-term immunosuppressive therapy after endovascular repair is important to limit pseudoaneurysm recurrence.

Profuse epistaxis following sphenoid surgery: a ruptured carotid artery pseudoaneurysm and its management

We report a rare case of iatrogenic pseudoaneurysm of the internal carotid artery secondary to endoscopic sphenoid surgery. The management of this unusual complication and a review of the literature are presented. A 65-year-old woman presented with intractable epistaxis four days following endoscopic sphenoid sinus surgery. Initial, conservative measures were unsuccessful in controlling bleeding. The clinical picture of delayed, severe epistaxis after a sphenoid sinus exploration raised the possibility of injury to the internal carotid artery and subsequent formation of a false aneurysm. The patient's pseudoaneurysm was managed, without visualising it, by packing the sphenoid sinus (achieved by palpating 1 cm above the shoulder of the posterior choana) in order to gain control of the haemorrhage, followed by endovascular occlusion. An awareness of this rare complication is essential in order to manage this life-threatening condition efficiently.

Ruptured Pseudoaneurysm of the External Iliac Artery in an Advanced Cervical Cancer Patient Treated by Endovascular Covered Stent Placement

The formation of pseudoaneurysms in patients with gynecologic malignancies is rare. We describe a patient with locally advanced cervical cancer who had life-threatening rectal bleeding due to a ruptured pseudoaneurysm of the right external iliac artery, which was successfully treated by emergent endovascular covered stent placement. This 56-year-old woman had received concurrent chemoradiation, salvage hysterectomy and systemic chemotherapy for advanced cervical cancer. About 25 months after her diagnosis of cervical cancer, she suffered from acute life-threatening rectal bleeding. Angiography revealed active extravasation from a pseudoaneurysm of the right external iliac artery. A covered stent was placed across the pseudoaneurysm via an endovascular approach to stop the bleeding. The patient recovered well without any sequelae. We believe that this technique might also be useful in other irradiated gynecologic cancer patients, especially when direct surgical repair is difficult to perform due to pelvic irradiation or tumor recurrence.

The management of bleeding pseudoaneurysms in patients with severe acute pancreatitis

To report the experience in diagnosis and management of bleeding pseudoaneurysms associated with severe acute pancreatitis (SAP). The medical records of 12 patients with bleeding pseudoaneurysms associated with SAP treated between October 1990 and October 2006 were retrospectively reviewed. The etiologies of the 12 patients were gallstones in 6 patients, hyperlipidemia in 3 patients, hyperparathyroidism in 1 patient and the other 2 patients had no definitive causes. Abdominal computed tomography revealed bleeding pseudoaneurysms in 6 of 9 patients. Angiography determined correct diagnosis in 12 patients (12/12). The most involved vessels were peripancreatic arteries. Eight patients were managed by trans-catheter arterial embolization (TAE) as "one point" (a proximal point of the pseudo-aneurysm). Two patients were treated by TAE as "two points" (both distal and proximal to the pseudo-aneurysm). The last two cases were treated by surgery as suture and ligation. Four of the "one point" TAE patients were re-bleeding 4 to 7 days later, and 2 of them were treated with surgery, the other 2 patients were controlled with "two points" TAE. Three patients were died of infection and multiple organ dysfunction syndromes. Overall mortality rate was 25% (3/12). Angiography is the main diagnostic methods for bleeding pseudoaneurysms in SAP patients. "Two points" embolization and emergency surgery are an effective treatment options in these patients.

COMBINATION OF TWO PSEUDOANEURYSMS IN A PATIENT 6 YEARS AFTER ASCENDING AORTA AND AORTIC VALVE REPLACEMENT

We report successful treatment of a patient 6 years after ascending aorta and aortic valve replacement suffering from a combination of two pseudoaneurysms. The first of them originated from the coronary ostial suture line and the second pseudoaneurysm originated from the distal suture line. We performed re-replantation of the left main trunk to the prosthesis and then we resected the pseudoaneurysm originating from the distal suture line and we replaced the entire aorta by a vascular graft. The postoperative convalescence was uneventful, the patient was discharged two weeks after the surgery. The patient is currently in a very good condition one year after the surgery. Coronary ostial pseudoaneurysm in patients after ascending aorta and aortic valve replacement with the use of "button technique" is a quite rare situation. The combination of two pseudoaneurysms originating from different suture lines in one patient seems to be unique in literature reviews.

Treatment of Bleeding Pseudoaneurysms in Patients with Chronic Pancreatitis

In patients with chronic pancreatitis, an actively bleeding pseudoaneurysm can be life-threatening. Angioembolization is an attractive alternative to often complex operative management, and its feasibility was assessed in a retrospective analysis. During 1993-2005, 33 patients (27 males, median age 51 years) with bleeding pancreatic pseudoaneurysms underwent urgent angiographic evaluation followed by angioembolization if possible. Angioembolization was performed in 23 patients, whereas 10 patients required hemostatic surgery, including 6 distal pancreatectomies and 3 vessel ligations. Between 1993 and 2005 33 out of 745 patients (4.4%) admitted for chronic pancreatitis had bleeding pancreatic pseudoaneurysms. The proportion of bleeders out of the total number of hospital admissions for chronic pancreatitis was 33 out of 1,892 (1.7%). The overall success rate of angioembolization was 22 out of 33 (67%) including 3 patients requiring re-embolization for recurrent bleeding. The success rate was 16 out of 20 (80%) when the pseudocyst was in the head of the pancreas, and only 50% when the splenic artery was the source of bleeding. Four of the 5 cases with free bleeding into the peritoneal cavity required operative intervention. The overall mortality and morbidity rates were 2 out of 33 (6%) and 7 out of 33 (21%) respectively, with no significant differences between embolized and operated patients. Angioembolization was associated with a significantly lower need for total blood transfusions and length of hospital stay. During the years 2000-2005, the overall success rate of angioembolization was 95%. All hemodynamically stable patients with chronic pancreatitis and bleeding pseudoaneurysms should undergo prompt initial angiographic evaluation and embolization if possible. Repeated angioembolization is feasible in patients with recurrent bleeding, whether initially embolized or operated. Patients with unsuccessful embolization should undergo emergency hemostatic surgery with ligation of the bleeding vessel in the head of the pancreas and distal resection in patients bleeding from the splenic artery or its branch. The combination of angioembolization and later endoscopic drainage of the pseudocyst via endoscopic retrograde cholangiopancreatography (ERCP) is effective in the majority of the cases of pseudoaneurysms in chronic pancreatitis.

Management and outcome of bleeding pseudoaneurysm associated with chronic pancreatitis

BackgroundA bleeding pseudoaneurysm in patients with chronic pancreatitis is a rare and potentially lethal complication. Optimal treatment of bleeding peripancreatic pseudoaneurysm remains controversial. This study reports on experience at Chang Gung Memorial Hospital (CGMH) in managing of bleeding pseudoaneurysms associated with chronic pancreatitis.MethodsThe medical records of 9 patients (8 males and 1 female; age range, 28 – 71 years; median, 36 years) with bleeding pseudoaneurysms associated with chronic pancreatitis treated at CGMH between Aug. 1992 and Sep. 2004 were retrospectively reviewed. Alcohol abuse (n = 7;78%) was the predominant predisposing factor. Diagnoses of bleeding pseudoaneurysms were based on angiographic (7/7), computed tomographic (4/7), ultrasound (2/5), and surgical (2/2) findings. Whether surgery or angiographic embolization was performed was primarily based on patient clinical condition. Median follow-up was 38 months (range, 4 – 87 months).ResultsAbdominal computed tomography revealed bleeding pseudoaneurysms in 4 of 7 patients (57%). Angiography determined correct diagnosis in 7 patients (7/7, 100%). The splenic artery was involved in 5 cases, the pancreaticoduodenal artery in 2, the gastroduodenal artery in 1, and the middle colic artery in 1. Initial treatment was emergency (n = 4) or elective (n = 3) surgery in 7 patients and arterial embolization in 2. Rebleeding was detected after initial treatment in 3 patients. Overall, 5 arterial embolizations and 9 surgical interventions were performed; the respective rates of success of these treatments were 20% (1/5) and 89% (8/9). Five patients developed pseudocysts before treatment (n = 3) or following intervention (n = 2). Pseudocyst formation was identified in 2 of the 3 rebleeding patients. Five patients underwent surgical treatment for associated pseudocysts and bleeding did not recur. One patient died from angiography-related complications. Overall mortality rate was 11% (1/9). Surgery-related mortality was 0%.ConclusionAngiography is valuable in localizing bleeding pseudoaneurysms. In this limited series, patients with bleeding pseudoaneurysms associated with chronic pancreatitis treated surgically seemingly obtained good outcomes.

Peripheral Pulmonary Artery Pseudoaneurysms and Massive Hemoptysis

The aim of this study was to determine the incidence and etiology of pulmonary artery pseudoaneurysms in patients undergoing bronchial angiography for massive hemoptysis and to assess patient outcome after the embolization of these pseudoaneurysms. Peripheral pulmonary artery pseudoaneurysms occur in up to 11% of patients undergoing bronchial angiography for hemoptysis. These are often most easily appreciated on bronchial and/or nonbronchial systemic arterial angiograms because of complete reversal of flow in pulmonary artery branches in the diseased lung. Embolization of bronchial and nonbronchial systemic arteries alone may not be sufficient therapy to control hemoptysis, and occlusion of the pseudoaneurysm itself via a pulmonary artery approach is recommended.