Selective embolization for bleeding visceral artery pseudoaneurysms in patients with pancreatitis

作     者：Harsheet Sethi Praveen Peddu Andreas Prachalias Pauline Kane John Karani Mohamed Rela Nigel Heaton 

作者机构：Department of Hepatobiliary Surgery Institute ofLiver StudiesKings College London School of Medicine at Kings College Hospital Department of Hepatobiliaryand Interventional RadiologyInstitute ofLiver StudiesKings College London School of Medicine at Kings College Hospital 

出 版 物：《Hepatobiliary & Pancreatic Diseases International》 (国际肝胆胰疾病杂志（英文版）)

年 卷 期：2010年第9卷第6期

页      面：634-638页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

基　　金：Medical Research Council [G0600698B] Funding Source: researchfish 

主　　题：pseudoaneurysm embolization acute pancreatitis chronic pancreatitis vascular complications 

摘      要：BACKGROUND:Pancreatitis is associated with arterial complications in 4%-10%of patients,with untreated mortality approaching 90%.Timely intervention at a specialist center can reduce the mortality to 15%.We present a single institution experience of selective embolization as first line management of bleeding pseudoaneurysms in pancreatitis. METHODS:Sixteen patients with pancreatitis and visceral artery pseudoaneurysms were identified from searches of the records of interventional angiography from January 2000 to June *** visceral artery aneurysms and pseudoaneurysms arising as a result of post-operative pancreatic or biliary leak were excluded from the study. RESULTS:In 50%of the patients,bleeding complicated the initial presentation of *** was the offending agent in 10 patients,gallstones in 3,trauma,drug-induced and idiopathic pancreatitis in one *** 16 patients had a contrast CT scan and 15 underwent coeliac axis angiography. The pseudoaneurysms ranging from 0.9 to 9.0 cm affected the splenic artery in 7 patients:hepatic in 3,gastroduodenal and right gastric in 2 each,and left gastric and pancreatico-duodenal in 1 *** patient developed spontaneous thrombosis of the *** patients had effective coil embolization of the *** patient needed surgical exclusion of the pseudoaneurysm following difficulty in accessing the coeliac axis *** were no episodes of re-bleeding and no in-hospital mortality. CONCLUSIONS:Pseudoaneurysms are unrelated to the severity of pancreatitis and major hemorrhage can occur irrespective of their ***-existent portal hypertension and sepsis increase the risk of *** and selective coil embolization is a safe and effective way to arrest the hemorrhage.