Treatment of pancreatic pseudoaneurysm with percutaneous transabdominal thrombin injection

Manazer, James R; Monzon, Jose R.; Dietz, Patrick A.; Moglia, Robert; Gold, Michael S.

doi:10.1016/s0741-5214(03)00454-3

Cited by 35 publications

(19 citation statements)

References 9 publications

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“…Recently, there have been several case reports describing the effective treatment of peripancreatic pseudaneurysms by percutaneous injection of thrombin directly into the sac of the pseudoaneurysms [13,14,15,16,17]. In such cases, the procedure has generally been done under either CT or ultrasound guidance in stable patients with unruptured pseudoaneurysms.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Thrombin Embolization of a Ruptured Peripancreatic Pseudoaneurysm

Ward¹,

Buckley²,

Doody³

et al. 2007

Digestion

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Peripancreatic pseudoaneurysm formation is a recognized complication of pancreatitis. When associated with an acute episode of pancreatitis, surgical treatment is often difficult due to the inflammatory process that surrounds the pseudoaneurysm. In the stable patient, transcatheter embolization is the treatment of choice of this complication. However, this is not always technically feasible, as the aneurysm may be supplied by small inaccessible branch vessels. Recently, percutaneous thrombin injection has been described as a possible alternative for pseudoaneurysms. This is generally performed under computed tomography guidance in stable patients with non-ruptured pseudoaneurysms. We describe an acutely ruptured peripancreatic pseudoaneurysm in a critically ill patient, in whom percutaneous thrombin injection under computed tomography guidance resulted in immediate stabilization and cure of the pseudoaneurysm.

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Section: Discussionmentioning

confidence: 99%

Percutaneous Thrombin Embolization of a Ruptured Peripancreatic Pseudoaneurysm

Ward¹,

Buckley²,

Doody³

et al. 2007

Digestion

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“…It was first described in 2000 by Kang for the use of post-catheterization femoral pseudoaneurysms, but can also be used for visceral pseudoaneurysms [29]. A pseudoaneurysm with a small neck and relatively slower flow is best suited for this procedure due to a lower propensity for distal embolization as well as lower probability of recanalization in the early post-injection period [16, 30, 31]. Thrombin injection can also be performed endoluminally by placing a microcatheter into the aneurysm sac.…”

Section: Discussionmentioning

confidence: 99%

Visceral artery pseudoaneurysms: two case reports and a review of the literature

Abdelgabar

d'Archambeau

et al. 2017

J Med Case Reports

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BackgroundVisceral artery pseudoaneurysms are relatively rare but have a high mortality rate in case of rupture. Their detection in the last decades is rising due to an increased use of computed tomography and angiography. However, due to the nonspecific nature of the clinical symptoms and signs, diagnosis is often delayed or missed. We describe two cases of patients presenting with nonspecific abdominal complaints and anemia leading to a diagnosis of visceral pseudoaneurysm. Both cases are successfully treated with a different endovascular intervention.Case presentationThe first case is a 67-year-old Caucasian man presenting with diffuse abdominal pain, vomiting, diarrhea, and weight loss. Digital angiography showed a complex pseudoaneurysm of the superior mesenteric artery. The patient was treated with stent placement and selective embolization of the afferent branches.The second patient is a 78-year-old Caucasian man with a history of chronic pancreatitis admitted with epigastric pain, rectal bleeding and melena. Angiography showed a pseudoaneurysm of the gastroduodenal artery. The patient was successfully treated with coil embolization.ConclusionsWe report two cases of visceral pseudoaneurysms and review the literature concerning etiology, presentation, diagnosis, and treatment.Visceral artery pseudoaneurysms should be considered in the differential diagnosis of a patient with nonspecific abdominal symptoms. Diagnosis is often made with computed tomography or computed tomography angiography but digital angiography remains the gold standard. Treatment options include surgical, endovascular or percutaneous interventions. The choice of treatment is case specific.

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“…Another option is to induce thrombosis of the pseudoaneurysm by percutaneous thrombin injection. 11,12 However, the disadvantage of this technique is the potential for thrombus propagation into the artery. 14 Previous studies report cases of SMA pseudoaneurysm after pancreatic surgery that were successfully treated by endovascular stenting.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12] Although uncommon, pseudoaneurysms after pancreaticoduodenectomy can lead to potentially serious consequences including rupture and hemorrhage. [2][3][4][5][6][7][8][9][10] For these reasons, pseudoaneurysms should be diagnosed and treated as soon as possible.…”

mentioning

confidence: 99%

Endovascular management of superior mesenteric artery pseudoaneurysm

Shrikhande

Khan

Gallagher

et al. 2011

Journal of Vascular Surgery

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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.

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Treatment of pancreatic pseudoaneurysm with percutaneous transabdominal thrombin injection

Cited by 35 publications

References 9 publications

Percutaneous Thrombin Embolization of a Ruptured Peripancreatic Pseudoaneurysm

Percutaneous Thrombin Embolization of a Ruptured Peripancreatic Pseudoaneurysm

Visceral artery pseudoaneurysms: two case reports and a review of the literature

Endovascular management of superior mesenteric artery pseudoaneurysm

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