Endovascular management of superior mesenteric artery pseudoaneurysm

Abstract

A 31-year-old man underwent a Whipple procedure for a pancreatic neuroendocrine tumor, which consists of a pancreaticoduodenectomy and reconstruction to restore intestinal continuity. Six weeks after the operation, he presented with severe mid-epigastric pain radiating to his back. Imaging studies revealed a large pseudoaneurysm arising from the superior mesenteric artery. Selective superior mesenteric angiography confirmed the presence of the pseudoaneurysm. A 6 mm × 2.5 cm stent graft (Viabhan; W.L. Gore, Flagstaff, Ariz) was deployed across the pseudoaneurysm origin with preservation of the mesenteric branches. The patient had immediate resolution of symptoms and follow-up imaging showed patency of the stent graft and exclusion of the pseudoaneurysm.

Transcatheter Arterial Embolization Treatment for Bleeding Visceral Artery Pseudoaneurysms in Patients with Pancreatitis or following Pancreatic Surgery

“…The effectiveness of covered stent embolization of the hepatic and superior mesenteric arteries has been reported [ 20 , 21 ]. A covered stent makes it possible to attain effective hemostasis and preserve vascular flow, and usually results in less hepatic complications than hepatic artery occlusion.…”

Giant visceral artery pseudoaneurysm treated with endovascular transradial coil embolization

“… 1 , 2 , 3 VAPAs occur secondary to arterial wall disruption that can result from infection, vasculitis, fibromuscular dysplasia, trauma, or iatrogenic causes. 1 , 3 , 4 The decreased integrity of the arterial wall makes VAPAs more prone to rupture than their true aneurysmal counterparts and can prove fatal. Visceral mycotic PSA, in particular, are most commonly confined to the SMA and in 2.5% to 10.0% of the cases are associated with infective endocarditis.…”

Postpancreatoduodenectomy Hemorrhage Treated by Combined Transcatheter Arterial Embolization and Superior Mesenteric Artery to Iliac Artery Bypass: Report of a Case

“…There are several reports of patients with good clinical courses after stent grafting. [11][12][13] However, the placement of a stent graft may be technically challenging, and the success of the procedure depends on the technique used and the experience of the radiologists or cardiologists involved, as well as the availability of the devices, particularly in emergent situations. Indeed, we made an unsuccessful attempt to deploy a CHA stent graft but were stymied by the technical difficulty in our hemodynamically unstable patient.…”