Successful treatment of pseudoaneurysms of celiac and superior mesenteric arteries by combined endovascular and surgical approach

Abstract

Pseudoaneurysm after pancreas resection poses serious complications, including rupture and hemorrhage. Here we report a case of delayed massive hemorrhage from celiac and superior mesenteric arteries, which was successfully treated with a combined endovascular and surgical approach. The patient was a 52-year-old man who presented with pseudoaneurysms of the celiac and superior mesenteric arteries after distal pancreatectomy. Following the detection of sentinel bleeding from the abdominal drain, emergency angiography of the celiac and superior mesenteric arteries revealed stenosis of the celiac artery and pseudoaneurysms in the superior mesenteric artery. We occluded these lesions with a platinum coil, using an interventional radiological technique combined with bypass grafting between the abdominal aorta and the SMA, using the saphenous vein. However, re-bleeding into the abdominal cavity occurred from the proximal SMA pseudoaneurysm. We inserted an endoluminal stent-graft into the abdominal aorta and completed bypass grafting between the aorta and bilateral renal arteries. The hemorrhage ceased and the postoperative course was uneventful. The patient was discharged 34 days after the treatment (149 days after the initial operation). In conclusion, this combined endovascular and surgical approach is feasible and seems appropriate for pseudoaneurysms arising from proximal sites in visceral arteries.

Coil migration – a rare complication of endovascular exclusion of visceral artery pseudoaneurysms and aneurysms

“…9,11,12 Whereas spontaneous thrombosis has been described rarely, 4 VAPAs usually require treatment in the form of surgical, 13 endovascular, 14 or combined approaches. 5 We describe a case, and review all similar reports, of coil migration following endovascular exclusion of a visceral artery pseudoaneurysm.…”

“…Visceral artery pseudoaneurysms or aneurysms (VAPA) of the splenic, 1 gastroduodenal, 2, 3 hepatic, 2 gastroepiploic, 4 superior mesenteric 5 or inferior mesenteric 6 (or any visceral branch of the coeliac axis, inferior mesenteric, superior mesenteric or renal arteries) arteries can form secondary to a variety of congenital, traumatic and inflammatory pathologies. Visceral artery aneurysms are found in 0.01-0.2% of routine autopsies but are being increasingly found incidentally in our ageing population; 7 whereas visceral artery pseudoaneurysm formation is a rare but potentially fatal complication occurring in less than 2% of cases of chronic pancreatitis (CP), 8 and even less frequently following acute pancreatitis and hepatopancreaticobiliary (HPB) surgery, 9 vasculitis or other inflammatory processes.…”

Endovascular Stent-Graft Treatment of Giant Celiac Artery Pseudoaneurysm

“…These procedures can be performed repeatedly or used in combination if intervention is unsuccessful. In addition, combined endovascular and surgical approach has been reported in the literature [ 10 ].…”

An anomalous engenderment of a common scenario: upper gastrointestinal bleeding

“…One of the major problems following coil embolization is the risk of recanalization, occurring with an incidence of 9-42.9%. 9 Length of the neck, tortuosity of the arteries, precise location of the aneurysm, and angulation of the aneurysmal tract remain pivotal factors in determining the success of the procedure.…”