Endovascular management of pancreatitis related pseudoaneurysms – A single center experience

Kulkarni, Chinmay; Moorthy, Srikanth; Pullara, Sreekumar Karumathil; Prabhu, Nirmal Kumar; Kannan, R.; Nazar, Puthukudiyil Kader

doi:10.1016/j.gii.2014.02.003

Cited by 12 publications

(14 citation statements)

References 15 publications

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“…Direct injection of NBCA into the pseudoaneurysm may lead to rupture of a friable-walled pseudoaneurysm due to increased pressure within the pseudoaneurysm. [11] We did not observe pseudoaneurysm rupture in any of our cases as a calculated minimal volume of NBCA: lipiodol mixture was injected.…”

Section: Discussionmentioning

confidence: 73%

“…[11] In our study, one patient was referred with a persistent bleeding cystic artery pseudoaneurysm due to refilling from inadequately coiled feeding replaced right hepatic artery (RHA) and from distal collaterals. As the pseudoaneurysm could not be accessed through the replaced RHA or through collaterals, direct puncture of the pseudoaneurysm and injection of NBCA: lipiodol mixture were done [Figure 3].…”

Section: Discussionmentioning

confidence: 99%

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Percutaneous Direct Needle Puncture and Transcatheter N-butyl Cyanoacrylate Injection Techniques for the Embolization of Pseudoaneurysms and Aneurysms of Arteries Supplying the Hepato-pancreato-biliary System and Gastrointestinal Tract

Yadav

Boruah

Bhattacharyya

et al. 2016

Journal of Clinical Imaging Science

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Aims:The aim of this study was to evaluate the safety and clinical efficacy of percutaneous direct needle puncture and transcatheter N-butyl cyanoacrylate (NBCA) injection techniques for the embolization of pseudoaneurysms and aneurysms of arteries supplying the hepato-pancreato-biliary (HPB) system and gastrointestinal (GI) tract.Subjects and Methods:A hospital-based cross-sectional retrospective study was conducted, where the study group comprised 11 patients with pseudoaneurysms/aneurysms of arteries supplying the HPB system and GI tract presenting to a tertiary care center from January 2015 to June 2016. Four patients (36.4%) underwent percutaneous direct needle puncture of pseudoaneurysms with NBCA injection, 3 patients (27.3%) underwent transcatheter embolization with NBCA as sole embolic agent, and in 4 patients (36.4%), transcatheter NBCA injection was done along with coil embolization.Results:This retrospective study comprised 11 patients (8 males and 3 females) with mean age of 35.8 years ± 1.6 (standard deviation [SD]). The mean volume of NBCA: ethiodized oil (lipiodol) mixture injected by percutaneous direct needle puncture was 0.62 ml ± 0.25 (SD) (range = 0.5–1 ml), and by transcatheter injection, it was 0.62 ml ± 0.37 (SD) (range = 0.3–1.4 ml). Embolization with NBCA was technically and clinically successful in all patients (100%). No recurrence of bleeding or recurrence of pseudoaneurysm/aneurysm was noted in our study.Conclusions:Percutaneous direct needle puncture of visceral artery pseudoaneurysms and NBCA glue injection and transcatheter NBCA injection for embolization of visceral artery pseudoaneurysms and aneurysms are cost-effective techniques that can be used when coil embolization is not feasible or has failed.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Percutaneous Direct Needle Puncture and Transcatheter N-butyl Cyanoacrylate Injection Techniques for the Embolization of Pseudoaneurysms and Aneurysms of Arteries Supplying the Hepato-pancreato-biliary System and Gastrointestinal Tract

Yadav

Boruah

Bhattacharyya

et al. 2016

Journal of Clinical Imaging Science

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“…This has been previously reported in the literature. 9,14,15 The less commonly involved vessels were left inferior phrenic artery (two patients), middle and left colic arteries (one patient), and left subcapsular renal artery (one patient). In literature, there are a few case reports of involvement of left renal artery, left inferior phrenic artery, and middle colic artery.…”

Section: Discussionmentioning

confidence: 99%

“…Transarterial embolization has been considered as the initial treatment especially in hemodynamically stable patients. 7,9,11,14,16 Surgery is reserved for patients with active bleeding, hemodynamically unstable patients, following failed embolization and for other secondary complications such as infection or extrinsic compression. 7,16 Mortality rate following surgical management can range from 20 to 50%, depending upon the patient's hemodynamic state, the bleeding location, and timing of the surgery.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Management of Pancreatitis-Related Hemorrhage: Single-Center Experience

Kumar

Singh

Kumar

et al. 2020

Journal of Clinical Interventional Radiology ISVIR

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Purpose The main purpose of this article is to assess the outcomes of endovascular management of pancreatitis-related hemorrhage. Materials and Methods Retrospective analysis of patients referred for endovascular management of pancreatitis-related bleeding from January 2010 to December 2017 was performed. Patients’ demographics, clinical presentation, etiology, laboratory findings, angiography findings, details of the endovascular procedure, technical outcome, clinical outcome, and complications were assessed. Results One hundred and five patients with a mean age of 37 years were included in this study. Splenic artery (41.7%) was the most commonly involved vessel. Middle colic, left colic, superior mesenteric, jejunal, left inferior phrenic, and left renal subcapsular arteries were the less commonly involved vessels. Embolization was performed using coils in 72 (68.5%) patients, n-butyl cyanoacrylate (n-BCA) in 21 (20%) patients, both coil and n-BCA in 8 (7.6%) patients, and 4 (3.8%) patients underwent stent graft placement. Technical success was achieved in 98% (n = 103) and clinical success in 93.2% (n = 96) of patients. Rebleeding was seen in 6.8% (n = 7) of patients. Six patients with rebleeding were managed by reintervention. Four patients had rebleeding from the same vessel, and two patients had rebleeding from a different vessel. One patient died due to massive rebleeding. Minor complications were seen in 14.2% (n = 15), major complications were seen in 3.8% (n = 4), and mortality rate was 0.9% (n = 1). Conclusion Endovascular treatment is effective in the management of pancreatitis-related bleeding and is associated with low rebleeding rate and low mortality rate.

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“…The incidence of pseudoaneurysm of visceral arteries in chronic pancreatitis is 7 to 10%, greater than in acute pancreatitis (1-6%). 46,47 Various mechanisms of pseudoaneurysm formation are as follows: enzymatic autodigestion of arterial wall leading to pseudoaneurysm formation, visceral artery eroding into pseudocyst converting pseudocyst into a pseudoaneurysm, and pseudocyst eroding into bowel wall with bleeding from the mucosal surface (►Fig. 9).…”

Section: Vascular Complicationsmentioning

confidence: 99%

Imaging of Tropical Chronic Pancreatitis—A Unique Clinico-Radiological Entity

Kulkarni

Sekhar

Moorthy

et al. 2019

Journal of Gastrointestinal and Abdominal Radiology

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Tropical chronic pancreatitis (TCP) is a unique juvenile nonalcoholic form of chronic pancreatitis prevalent in tropical developing countries. TCP is characterized by the younger age of onset, rapid progression, higher prevalence of diabetes and pancreatic calculi, and greater propensity to develop pancreatic malignancy. Identifying the distinct imaging features is critical for the diagnosis of TCP. Awareness of this condition will not only enable the radiologist to recognize it early but also help in better management. In this article, we review the etiopathogenesis, distinct imaging features, and complications of TCP.

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Endovascular management of pancreatitis related pseudoaneurysms – A single center experience

Cited by 12 publications

References 15 publications

Percutaneous Direct Needle Puncture and Transcatheter N-butyl Cyanoacrylate Injection Techniques for the Embolization of Pseudoaneurysms and Aneurysms of Arteries Supplying the Hepato-pancreato-biliary System and Gastrointestinal Tract

Percutaneous Direct Needle Puncture and Transcatheter N-butyl Cyanoacrylate Injection Techniques for the Embolization of Pseudoaneurysms and Aneurysms of Arteries Supplying the Hepato-pancreato-biliary System and Gastrointestinal Tract

Endovascular Management of Pancreatitis-Related Hemorrhage: Single-Center Experience

Imaging of Tropical Chronic Pancreatitis—A Unique Clinico-Radiological Entity

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