Endovascular treatment of pseudoaneurysms secondary to chronic pancreatitis: reports of two cases

Santos, Fabiana Seifert; Sousa, Karolaine Marcelina da Silva; Castro, Thiago Augusto Cadorin de; Neto, Felipe Coelho; Oliveira, Rodrigo Gomes de; Araújo, Walter Junior Boim de; Santos, Liliãn Cabral Pereira dos; Souza, Raquel Canzi Almada de

doi:10.1590/1677-5449.012517

Cited by 3 publications

(3 citation statements)

References 17 publications

(18 reference statements)

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“… 14 Conventional open techniques include resection with revascularization and ligature or final resection of the organ (generally splenectomy) and remain the gold standard treatment. 8 , 15 However, they can very often cut off the blood flow in the principal artery and cause intestinal ischemia of varying degrees. 14 …”

Section: Discussionmentioning

confidence: 99%

“…Houve, então, a necessidade de classificação para se decidir qual procedimento realizar: cirúrgico (aberto ou embolização por cateter) ou seguimento conservador 14 . A técnica aberta convencional que inclui ressecção com revascularização, ligadura ou ressecção final do órgão (em geral, esplenectomia) ainda permanece como padrão ouro de tratamento 8 , 15 . No entanto, pode, muitas vezes, interromper o fluxo sanguíneo da artéria principal e resultar em um quadro de isquemia intestinal em diferentes escalas 14 .…”

Section: Introductionunclassified

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Pseudoaneurisma roto de artéria ileocólica: relato de caso

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Resumo Os aneurismas de artérias viscerais (AAVs) e pseudoaneurismas de artérias viscerais (PAAVs) são condições raras e potencialmente letais quando rotos. Em geral, são encontrados incidentalmente na tomografia computadorizada de pacientes assintomáticos. Embora a cirurgia aberta convencional seja considerada atualmente o tratamento padrão ouro, a abordagem endovascular vem ganhando relevo por ser considerada um procedimento minimamente invasivo e com riscos cirúrgicos menores. Destaca-se, nessa abordagem, o uso de embolização por molas (coils) em AAVs e PAAVs saculares e implante de stent modulador de fluxo como alternativa de tratamento para aneurismas fusiformes. Apresentamos o caso de uma paciente de 51 anos com queixa de dor abdominal aguda, taquicardia e hipotensão, com evidência de sangramento abdominal em angiotomografia e diagnóstico de pseudoaneurisma de artéria ileocólica (AIC) roto. Ela foi submetida a tratamento endovascular precoce de embolização da AIC com sucesso, e houve melhora do quadro clínico.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionunclassified

Pseudoaneurisma roto de artéria ileocólica: relato de caso

et al. 2021

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“…Moreover, early embolization can help reduce the number of transfusions to be given. DSA has a very low incidence of postoperative complications, morbidity, and mortality [14]. If such facilities are unavailable or endovascular management has failed, or the patient is unstable due to rupture of an aneurysm, then surgery is the better option.…”

Section: Treatment Of Patients Withmentioning

confidence: 99%

Left Gastric Artery Pseudoaneurysm Due to Pancreatitis

Gaur¹,

Shaikh²,

S³

et al. 2021

Cureus

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Acute or chronic pancreatitis can cause pseudoaneurysms of visceral arteries. The left gastric artery (LGA) is the least common visceral artery being affected. Here, we report a case of chronic pancreatitis with a pseudoaneurysm of the LGA. A 42-year-old male, a chronic alcoholic, and smoker, presented with abdominal pain, haematemesis, and melena. Diagnosis of pseudoaneurysm of LGA aneurysm was confirmed by computed tomography abdomen. The endovascular coil embolization was done successfully, following which the patient had an uneventful recovery.

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Endovascular and Open Surgical Treatment of Ruptured Splenic Artery Aneurysms: A Case Report and a Systematic Literature Review

Rinaldi,

Brioschi,

Marone

2023

JCM

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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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Endovascular treatment of pseudoaneurysms secondary to chronic pancreatitis: reports of two cases

Cited by 3 publications

References 17 publications

Pseudoaneurisma roto de artéria ileocólica: relato de caso

Pseudoaneurisma roto de artéria ileocólica: relato de caso

Left Gastric Artery Pseudoaneurysm Due to Pancreatitis

Endovascular and Open Surgical Treatment of Ruptured Splenic Artery Aneurysms: A Case Report and a Systematic Literature Review

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