Percutaneous Thrombin Embolization of a Ruptured Peripancreatic Pseudoaneurysm

Abstract

Peripancreatic pseudoaneurysm formation is a recognized complication of pancreatitis. When associated with an acute episode of pancreatitis, surgical treatment is often difficult due to the inflammatory process that surrounds the pseudoaneurysm. In the stable patient, transcatheter embolization is the treatment of choice of this complication. However, this is not always technically feasible, as the aneurysm may be supplied by small inaccessible branch vessels. Recently, percutaneous thrombin injection has been described as a possible alternative for pseudoaneurysms. This is generally performed under computed tomography guidance in stable patients with non-ruptured pseudoaneurysms. We describe an acutely ruptured peripancreatic pseudoaneurysm in a critically ill patient, in whom percutaneous thrombin injection under computed tomography guidance resulted in immediate stabilization and cure of the pseudoaneurysm.

Direct puncture embolization using N-butyl cyanoacrylate for a hepatic artery pseudoaneurysm

“…Since that time, the procedure has been widely accepted for the treatment of visceral pseudoaneurysm (5-10). Image-guided puncture could be performed under utrasound, fluoroscopy, CT-guidance, and CT fluoroscopy (5)(6)(7)(8)(9)(10). In this present case, utrasound, enhanced and non-enhanced CT failed to reveal the pseudoaneurysm that was adjacent to the EBD tube.…”

“…Previous studies have described direct puncture with needle sizes ranging from 23-gauge to 18-gauge (5)(6)(7)(8)(9)(10). In the present case, a 22-gauge needle (Cathelin, Terumo Europe) was used, which was the smallest needle available in the emergency setting.…”

“…Embolic materials used for direct percutaneous embolization for visceral pseudoaneurysms include coils (5,6) and thrombin (9,10). However, there are only a few reports describing direct puncture of a visceral pseudoaneurysm using NBCA (7,8).…”

“…Transcatheter embolization is a well-established treatment for ruptured pseudoaneurysm (2)(3)(4), but previous intervention may make the pseudoaneurysm inaccessible by the transcatheter approach (5)(6)(7)(8)(9)(10). Embolization of pseudoaneurysms by direct puncture has been described previously in the literature as an alternative to the transcatheter approach (5)(6)(7)(8)(9)(10)(11). However, there are only a few reports describing direct puncture of a visceral pseudoaneurysm for embolization with N-butyl cyanoacrylate (NBCA) (7,8).…”

The use of thrombin in the radiology department

“…While the majority of cases treated by thrombin have involved stable patients with intact pseudoaneurysms, there have been some recent reports in the literature describing the successful treatment with percutaneous thrombin of a ruptured visceral pseudoaneurysm in an unstable patient [28].…”