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Major and minor complications of the pancreas after transcatheter arterial embolization using n-butyl-2-cyanoacrylate for acute bleeding from pancreatic arteries

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Abstract

Purpose

The purpose is to investigate the major and minor complications of the pancreas after transcatheter arterial embolization (TAE) using n-butyl-2-cyanoacrylate (NBCA) for bleeding from pancreatic arteries.

Materials and methods

Thirty-three patients who underwent TAE using NBCA for acute bleeding from pancreatic arteries and their parent arteries followed by contrast-enhanced computed tomography (CE-CT) were evaluated retrospectively. Complications and risk factors were assessed using Mann–Whitney U test or Fisher’s exact test for the univariate analysis. Patients’ characteristic, embolized artery, procedure details, and clinical outcomes were examined as possible risk factors.

Results

TAE was performed successfully in all patients. Minor pancreatic complications occurred in 10 patients (30%), including acute mild pancreatitis (n = 4) and focal lack of pancreatic parenchymal enhancement on CE-CT without pancreatitis (n = 6). No cases of major pancreatic complications, such as moderate/severe pancreatitis, were reported. Embolized artery was the only significant risk factor. The rate of complications per embolized artery were 15% (three out of 20 patients) in the arteries of the pancreatic head and 54% (seven out of 13 patients) in the arteries of pancreatic body and tail (p = 0.025).

Conclusion

TAE using NBCA for acute bleeding from pancreatic arteries is efficacious and safe. Mild pancreatic complications were observed more frequently in case of embolization of the pancreatic body and tail region than the pancreatic head.

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References

  1. Flati G, Andrén-Sandberg A, La Pinta M, Porowska B, Carboni M. Potentially fatal bleeding in acute pancreatitis: pathophysiology, prevention, and treatment. Pancreas. 2003;26:8–14.

    Article  Google Scholar 

  2. Barge JU, Lopera JE. Vascular complications of pancreatitis: role of interventional therapy. Korean J Radiol. 2012;13(Suppl 1):S45-55.

    Article  Google Scholar 

  3. de Weerth A, Buggisch P, Nicolas V, Maas R. Pancreaticoduodenal artery aneurysm—a life-threatening cause of gastrointestinal hemorrhage: case report and review of the literature. Hepatogastroenterology. 1998;45:1651–4.

    PubMed  Google Scholar 

  4. Izaki K, Yamaguchi M, Kawasaki R, Okada T, Sugimura K, Sugimoto K. N-butyl cyanoacrylate embolization for pseudoaneurysms complicating pancreatitis or pancreatectomy. J Vasc Interv Radiol. 2011;22:302–8.

    Article  Google Scholar 

  5. Kickuth R, Hoppe H, Saar B, Inderbitzin D, Triller J, Raessler S, et al. Superselective transcatheter arterial embolization in patients with acute peripancreatic bleeding complications: review of 44 cases. Abdom Radiol (NY). 2016;41:1782–92.

    Article  Google Scholar 

  6. Kim J, Shin JH, Yoon H-K, Ko G-Y, Gwon DI1, Kim EY, et al. Endovascular intervention for management of pancreatitis-related bleeding: a retrospective analysis of thirty-seven patients at a single institution. Diagn Interv Radiol. 2015;21:140–7.

    Article  Google Scholar 

  7. Won Y, Lee SL, Kim Y, Ku YM. Clinical efficacy of transcatheter embolization of visceral artery pseudoaneurysms using n-butyl cyanoacrylate (NBCA). Diagn Interv Imaging. 2015;96:563–9.

    Article  CAS  Google Scholar 

  8. Hyare H, Desigan S, Brookes JA, Guiney MJ, Lees WR. Endovascular management of major arterial hemorrhage as a complication of inflammatory pancreatic disease. J Vasc Interv Radiol. 2007;18:591–6.

    Article  Google Scholar 

  9. Vander Mijnsbrugge W, Laleman W, Van Steenbergen W, Heye S, Verslype C, Maleux G. Long-term clinical and radiological outcome of endovascular embolization of pancreatitis-related pseudoaneurysms. Acta Radiol. 2017;58:316–22.

    Article  Google Scholar 

  10. Ai M, Lu G, Xu J. Endovascular embolization of arterial bleeding in patients with severe acute pancreatitis. Wideochir Inne Tech Maloinwazyjne. 2019;14:401–7.

    PubMed  PubMed Central  Google Scholar 

  11. Kish JW, Katz MD, Marx MV, Harrell DS, Hanks SE. N-butyl cyanoacrylate embolization for control of acute arterial hemorrhage. J Vasc Interv Radiol. 2004;15:689–95.

    Article  Google Scholar 

  12. Tokuda T, Tanigawa N, Kariya S, Komemushi A, Nomura M, Suzuki S, et al. Pancreatitis after transcatheter embolization of a splenic aneurysm. Jpn J Radiol. 2010;28:239–42.

    Article  Google Scholar 

  13. Numoto I, Tsurusaki M, Oda T, Yagyu Y, Ishii K, Murakami T. Transcatheter arterial embolization treatment for bleeding visceral artery pseudoaneurysms in patients with pancreatitis or following pancreatic surgery. Cancers (Basel). 2020;12:2733.

    Article  CAS  Google Scholar 

  14. Okada T, Yamaguchi M, Takahashi T, Izaki K, Uotani K, Sakamoto N, et al. Is embolization of the pancreas safe? Pancreatic histological changes after selective transcatheter arterial embolization with n-butyl cyanoacrylate in a swine model. Cardiovasc Intervent Radiol. 2012;35:161–7.

    Article  Google Scholar 

  15. Okahara M, Mori H, Kiyosue H, Yamada Y, Sagara Y, Matsumoto S. Arterial supply to the pancreas; variations and cross-sectional anatomy. Abdom Imaging. 2010;35:134–42.

    Article  Google Scholar 

  16. Souza GD, Souza LR, Cuenca RM, Jerônimo BS, Souza GM, Vilela VM. Understanding the international consensus for acute pancreatitis: classification of Atlanta 2012. Arq Bras Cir Dig. 2016;29:206–10.

    Article  Google Scholar 

  17. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–11.

    Article  Google Scholar 

  18. Mortele KJ, Wiesner W, Intriere L, Shankar S, Zou KH, Kalantari BN, et al. Modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome. Am J Roentgenol. 2004;183:1261–5.

    Article  Google Scholar 

  19. Cardella JF, Kundu S, Miller DL, Millward SF, Sacks D. Society of Interventional Radiology. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol. 2009;20:S189–91.

    Article  Google Scholar 

  20. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.

    Article  CAS  Google Scholar 

  21. Suda K. Pancreas-pathological practice and research. Basel: Karger; 2007. p. 36–44.

    Book  Google Scholar 

  22. McKay JW, Baggenstoss AH, Wollaeger EE. Infarcts of the pancreas. Gastroenterology. 1958;35:256–64.

    Article  CAS  Google Scholar 

  23. Covantev S, Mazuruc N, Belic O. The arterial supply of the distal part of the pancreas. Surg Res Pract. 2019;2019:5804047.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Henry BM, Skinningsrud B, Saganiak K, Pękala PA, Walocha JA, Tomaszewski KA. Development of the human pancreas and its vasculature—an integrated review covering anatomical, embryological, histological, and molecular aspects. Ann Anat. 2019;221:115–24.

    Article  Google Scholar 

  25. Jim J, Caputo FJ, Sanchez LA. Intentional coverage of the celiac artery during thoracic endovascular aortic repair. J Vasc Surg. 2013;58:270–5.

    Article  Google Scholar 

  26. Haan JM, Bochicchio GV, Kramer N, Scalea TM. Nonoperative management of blunt splenic injury: a 5 year experience. J Trauma. 2005;58:492–8.

    Article  Google Scholar 

  27. Ekeh AP, McCarthy MC, Woods RJ, Haley E. Complications arising from splenic embolization after blunt splenic trauma. Am J Surg. 2005;189:335–9.

    Article  Google Scholar 

  28. Yamakado K, Nakatsuka A, Tanaka N, Takano K, Matsumura K, Takeda K. Transcatheter arterial embolization of ruptured pseudoaneurysms with coils and n-butyl cyanoacrylate. J Vasc Interv Radiol. 2000;11:66–72.

    Article  CAS  Google Scholar 

  29. Hur S, Jae HJ, Lee H, Lee M, Kim HC, Chung JW. Superselective embolization for arterial upper gastrointestinal bleeding using n-butyl cyanoacrylate: a single-center experience in 152 Patients. J Vasc Interv Radiol. 2017;28:1673–80.

    Article  Google Scholar 

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Funding

This study was not supported by any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan

    Koji Sasaki, Takuya Okada, Masato Yamaguchi, Masashi Tajiri, Mostafa Ahmed, Tomoyuki Gentsu, Eisuke Ueshima, Keitaro Sofue, Koji Sugimoto & Takamichi Murakami

Authors
  1. Koji Sasaki
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  2. Takuya Okada
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  3. Masato Yamaguchi
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  4. Masashi Tajiri
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  5. Mostafa Ahmed
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  6. Tomoyuki Gentsu
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  7. Eisuke Ueshima
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  8. Keitaro Sofue
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  9. Koji Sugimoto
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  10. Takamichi Murakami
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Contributions

Conceptualization: KS, TO, MY, and KS; Methodology: KS, TO, and MY; Formal analysis and investigation: KS, TO, MT, MA, TG, and EU; Writing—original draft preparation: KS and TO; Writing—review and editing: KS, TO, EU, and KS; Supervision: KS, MY, KS, and TM.

Corresponding author

Correspondence to Takuya Okada.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures involving human participants were conducted in accordance with the ethical standards of the institutional review board and/or national guidelines and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Institutional Review Board of Kobe University Hospital (B190108).

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The need for informed consent was waived by the Institutional Review Board.

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Sasaki, K., Okada, T., Yamaguchi, M. et al. Major and minor complications of the pancreas after transcatheter arterial embolization using n-butyl-2-cyanoacrylate for acute bleeding from pancreatic arteries. Jpn J Radiol 40, 308–317 (2022). https://doi.org/10.1007/s11604-021-01203-8

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  • DOI: https://doi.org/10.1007/s11604-021-01203-8

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