Pseudoaneurysm (PSA) of the visceral arterial tree is an uncommon but highly lethal complication of pancreatic surgery and pancreatitis. Surgical and angiographic interventions are used in treatment; however, optimal therapy remains unclear. We hypothesized that the natural history of PSA is different in these discrete clinical settings. From 1995–2005, 37 patients with PSA were treated: 13 after pancreatic surgery and 24 in the setting of pancreatitis. Postoperative patients most frequently presented with bleeding (92%), either from the gastrointestinal (GI) tract or a surgical drain. In this group, the diagnosis was most commonly made by angiography (77%), and 62% had a pancreatic fistula. In patients with pancreatitis, abdominal pain was the only presenting symptom in 62%, and GI bleeding was present in 29%. Eighty-seven percent had an associated pseudocyst or fluid collection. Interventional radiologic therapy successfully arrested hemorrhage in all 35 patients in whom it was employed. There were four false negative angiograms, and two patients required repeated interventions for rebleeding. The overall mortality was 14%. Pseudoaneurysms present differently in these two clinical settings, but transcatheter intervention is the first treatment of choice in clinically stable patients. Early recognition and prompt angiographic occlusion leads to improved outcomes.
Pseudoaneurysm Pancreatitis Pancreatic surgery Angiography
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The authors wish to thank Kristen Richards for secretarial support and Jian Yu for statistical expertise.
Sato N, Yamaguchi K, Shimizu S, Morisaki T, Yokohata K, Chijiiwa K, et al. Coil embolization of bleeding visceral pseudoaneurysms following pancreatectomy: the importance of early angiography. Arch Surg 1998;133(10):1099–10102.PubMedCrossRefGoogle Scholar
Balachandra S, Siriwardena AK. Systematic appraisal of the management of the major vascular complications of pancreatitis. Am J Surg 2005;190(3):489–495.PubMedCrossRefGoogle Scholar
Beattie GC, Hardman JG, Redhead D, Siriwardena AK. Evidence for a central role for selective mesenteric angiography in the management of the major vascular complications of pancreatitis. Am J Surg 2003;185(2):96–102.PubMedCrossRefGoogle Scholar
de Perrot M, Berney T, Buhler L, Delgadillo X, Mentha G, Morel P. Management of bleeding pseudoaneurysms in patients with pancreatitis. Br J Surg 1999;86(1):29–32.PubMedCrossRefGoogle Scholar
Sohn TA, Yeo CJ, Cameron JL, Geschwind JF, Mitchell SE, Venbrux AC, et al. Pancreaticoduodenectomy: role of interventional radiologists in managing patients and complications. J Gastrointest Surg 2003;7(2):209–219.PubMedCrossRefGoogle Scholar
Schmidt CM, Powell ES, Yiannoutsos CT, Howard TJ, Wiebke EA, Wiesenauer CA, et al. Pancreaticoduodenectomy: a 20-year experience in 516 patients. Arch Surg 2004;139(7):718–725; discussion 725–727.PubMedCrossRefGoogle Scholar
de Castro SM, Kuhlmann KF, Busch OR, van Delden OM, Lameris JS, van Gulik TM, et al. Delayed massive hemorrhage after pancreatic and biliary surgery: embolization or surgery? Ann Surg 2005;241(1):85–91.PubMedGoogle Scholar
Bergert H, Hinterseher I, Kersting S, Leonhardt J, Bloomenthal A, Saeger HD. Management and outcome of hemorrhage due to arterial pseudoaneurysms in pancreatitis. Surgery 2005;137(3):323–328.PubMedCrossRefGoogle Scholar
Waltman AC, Luers PR, Athanasoulis CA, Warshaw AL. Massive arterial hemorrhage in patients with pancreatitis. Complementary roles of surgery and transcatheter occlusive techniques. Arch Surg 1986;121(4):439–443.PubMedGoogle Scholar
Choi SH, Moon HJ, Heo JS, Joh JW, Kim YI. Delayed hemorrhage after pancreaticoduodenectomy. J Am Coll Surg 2004;199(2):186–191.PubMedCrossRefGoogle Scholar
Tien YW, Lee PH, Yang CY, Ho MC, Chiu YF. Risk factors of massive bleeding related to pancreatic leak after pancreaticoduodenectomy. J Am Coll Surg 2005;201(4):554–559.CrossRefGoogle Scholar
Boudghene F, L’Hermine C, Bigot JM. Arterial complications of pancreatitis: diagnostic and therapeutic aspects in 104 cases. J Vasc Interv Radiol 1993;4(4):551–558.PubMedCrossRefGoogle Scholar
Shankar S, Russell RC. Haemorrhage in pancreatic disease. Br J Surg 1989;76(8):863–866.PubMedGoogle Scholar
Gambiez LP, Ernst OJ, Merlier OA, Porte HL, Chambon JP, Quandalle PA. Arterial embolization for bleeding pseudocysts complicating chronic pancreatitis. Arch Surg 1997;132(9):1016–1021.PubMedGoogle Scholar
Shibata T, Sagoh T, Ametani F, Maetani Y, Itoh K, Konishi J. Transcatheter microcoil embolotherapy for ruptured pseudoaneurysm following pancreatic and biliary surgery. Cardiovasc Interv Radiol 2002;25(3):180–185.CrossRefGoogle Scholar