Coil Embolization of a Ruptured Gastroduodenal Artery Pseudoaneurysm Presenting with Hemosuccus Pancreaticus

Abstract

a filter to trap the debris before re-infusing the blood. The use of AngioVac in the treatment of thrombus in the arterial system has yet to be described. We present the first case report of successful treatment of symptomatic thoracoabdominal mural and floating intra-aortic thrombus using a thoracic endograft (C-TAG; W. L. Gore and Associates, Flagstaff, Ariz) in conjunction with the AngioVac device.Objectives: A 46-year-old female presented with primary aortic mural thrombus beginning mid descending aorta with extension distally into the celiac artery and evidence of visceral embolization demonstrated on computed tomography angiography (CTA) (Fig 1). The patient was taken to the angiography suite for exclusion of the aortic thrombus with an endograft in conjunction with percutaneous celiac thrombectomy.Methods: Follow-up CTA revealed thrombus extending from beneath the distal landing zone of the endograft into the abdominal aorta which appeared to be floating in the visceral segment.The patient was brought back to the angiography suite for AngioVac thrombectomy. Bilateral femoral cutdowns were performed and the Angiovac device was placed through the iliofemoral arterial system into the abdominal aorta with the return venous cannula placed in the contralateral femoral vein.Results: Successful extraction of the thrombus was achieved and confirmed on follow-up CTA imaging (Fig 2).Conclusions: This case demonstrates the effective utilization of an endograft and AngioVac thrombectomy as an effective treatment option for select patients with symptomatic primary thoracoabdominal aortic mural thrombus. Ease of use and low risk profile suggests this technique could become a front line option for select patients. Long-term follow-up will be necessary to assess durability of this technique .

Getting Closer to an Underdiagnosed Disease: Hemosuccus Pancreaticus, a Rare Cause of Upper Gastrointestinal Bleeding

“…Ultrasonography helps in identifying pancreatic pseudocysts or near-pancreatic aneurysms. Contrast-enhanced computed tomography with angiography represents an excellent diagnostic tool, revealing structural abnormalities of the pancreas, such as features of chronic pancreatitis, pseudocysts, as well as its surrounding vasculature [13], and leads to diagnosis in 90% of cases [11]. Interventional therapies are the first-line option given in hemodynamically stable patients [14], with high success and reduced mortality, which is why selective arteriography is the gold standard for diagnosis and treatment, with a sensitivity of 96% and a success rate higher than 70%, and even 88% in some recent studies [9,10].…”

Haemosuccus pancreatitis: A rare cause of GI bleed, diagnosis on CT Angiography – Case series & review of literature

“…Also, tortuosity or sharp angulations of the vessel preclude stent placement [25]. Endovascular therapy has been shown to achieve successful hemostasis in 75-100% of the cases with a low post procedure mortality [24,26]. Potential complications include bowel ischemia, splenic infarction and coil or stent migration [27].…”

Hemosuccus pancreatitis due to a ruptured splenic artery pseudoaneurysm - diagnosis and endovascular management

“…Also, tortuosity or sharp angulations of the vessel preclude stent placement [22]. Endovascular therapy has been shown to achieve successful hemostasis in 75-100% of the cases with a low post procedure mortality [21,23]. Potential complications include bowel ischemia, splenic infarction and coil or stent migration [24].…”