Stent placement is effective on both postoperative hepatic arterial pseudoaneurysm and subsequent portal vein stricture: A case report

Abstract

To treat postoperative bleeding after hepato-pancreatobiliary surgery, interventional radiology has become essential. We report a case of coincidental pseudoaneurysm and jejunal varices that were both successfully treated by stent-grafts. After a pancreaticoduodenectomy, the patient developed a pseudoaneurysm in the hepatic artery and a stenosis in its periphery. After establishing hepatic arterial flow by placing stent-grafts over both the pseudoaneurysm and the stenosis, the pseudoaneurysm was embolized with microcoils. Nine months later, the patient developed jejunal varices caused by a severe stricture in the main trunk of the portal vein. Percutaneous transhepatic portography was performed and stent-grafts were placed over the stenotic segment. A venoplasty using stent-grafts normalized the portal blood flow and the jejunal varices vanished. Although stenosis occurred due to scarred tissues from leakage after pancreaticoduodenectomy, stent-grafts were useful for managing jejunal bleeding post-operatively.

Intraabdominal hemorrhage after a pancreatectomy

“…Recently, hemostatic treatment using stent‐grafts has been reported ,. The placement of a polytetrafluoroethylene (PTFE) covered stent can be used both for hemostasis from pseudoaneurysms and to preserve the patency of the hepatic artery.…”

“…Recently, hemostatic treatment using stent-grafts has been reported. 15,[31][32][33][34][35] The placement of a polytetrafl uoroethylene (PTFE) covered stent can be used both for hemostasis from pseudoaneurysms and to preserve the patency of the hepatic artery. The placement of these stents is technically challenging with the currently avail-able stent-graft devices, which vary from 2.5 mm to 6 mm in diameter, [31][32][33][34][35] but the use of these stents offers an alternative for situations in which the collateral hepatic arterial supply is insuffi cient or the portal vein is compromised.…”

Stent Placement for Portal Vein Stenosis After Pancreaticoduodenectomy

“…[8][9][10][13][14][15][16][17][18][19].Olcott et al reported the first case after liver transplantation in 1990 [20], and Hiraoka et al reported the first case of PV stenosis after PD in 2001…”

Rupture of Pseudoaneurysm after Biliary Metallic Stent Placement

“…In cases of postsurgical biliary PA, SEMS placement is reported to be an effective treatment (21, 22). Cases of post-stenting PA all develop biliary bleeding, so a covered SEMS might be a useful tool for achieving pressure hemostasis and may be a viable treatment choice.…”