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KMID : 1048120140030010046
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International Journal of Gastrointestinal Intervention
2014 Volume.3 No. 1 p.46 ~ p.53
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Endovascular management of pancreatitis related pseudoaneurysms ?A single center experience
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Kulkarni Chinmay Bhimaji
Moorthy Srikanth
Pullara Sreekumar Karumathil
Prabhu Nirmal Kumar
Kannan Ramiah Rajesh
Nazar Puthukudiyil Kader
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Abstract
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Background: To retrospectively analyze the imaging characteristics, techniques, and outcome in patients who underwent endovascular treatment for pancreatitis-related pseudoaneurysms.
Methods: The study included 38 patients with pancreatitis who had pseudoaneurysm as a complication and who had been treated by endovascular methods between 2000 and 2013. Of the 38 patients, 24 (male:female = 21:3; average age 41.5 years) had imaging features of chronic pancreatitis. Fourteen patients (male:female = 12:2; average age 54.9 years) had features of acute pancreatitis. Computed tomography and digital subtraction angiography features of the pseudoaneurysms, endovascular technique and outcome in these patients were analyzed.
Results: The average size of pseudoaneurysms in patients with acute pancreatitis was 24.2 mm and 24.7 mm in those with chronic pancreatitis. No statistically significant (P = 0.913) difference in size was noted. Pseudoaneurysms in patients with chronic pancreatitis had more well-defined and thicker walls (average wall thickness 18.1 mm). Coil embolization was performed in 26 patients (68.4%). N-butyl cyanoacrylate embolization was done in five patients (13.1%). A covered stent was used in one patient (2.6%). A combination of techniques was used in five patients (13.1%) and gelfoam embolization alone was performed in one patient (2.6%). Technical success was achieved in 37 patients (97.3%). Reintervention was done in one patient. The mean imaging follow-up time was 10.74 months (3 days?84 months) and was available in 35 patients (92.1%). One patient died because of sepsis related to pancreatitis.
Conclusion: Endovascular treatment is an effective first line of management in pancreatic pseudoaneurysms. The endovascular technique depends on the vascular location and morphological features of the pseudoaneurysm.
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KEYWORD
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computed tomography, digital subtraction angiography, embolization, pancreatitis, pseudoaneurysms
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