Pseudoaneurysm of the Gastroduodenal Artery Secondary to Chronic Pancreatitis

Hepatic Artery Pseudoaneurysm with Extrahepatic Biliary Obstruction

“…Pancreatitis, abdominal trauma, and iatrogenic causes (e.g., prior abdominal surgery or endovascular interventions) have been reported as risk factors for hepatic artery pseudoaneurysm. 1,3,6,8) In the present case, chronic pancreatitis seemed to play a role in weakening the common hepatic artery wall. The mechanisms of pseudoaneurysm formation in pancreatitis include inflammation with enzymatic digestion of the pancreatic or peripancreatic artery, visceral artery erosion by pseudocysts, and pseudocyst erosion into the bowel wall and intramural artery.…”

“…4,5) The splenic artery is the most commonly involved vessel, accounting for half of cases of pseudoaneurysms in chronic pancreatitis, particularly because of its anatomic location. 6) The frequency of hepatic artery pseudoaneurysms due to chronic pancreatitis is comparatively uncommon at 2% to 12%. 2,7) However, since the 1980s, the growing use of percutaneous diagnostic and endoscope therapeutic procedures on the biliary tract has resulted in an increased number of visceral artery pseudoaneurysms, especially of the hepatic artery.…”

“…7) The most frequent complication is the persistent blood flow in the pseudoaneurysm, which is usually caused by a proximal occlusion without distal closure of the artery, resulting in retrograde filling of the pseudoaneurysm through collateral vessels. 6) It is difficult to completely pack a large saccular pseudoaneurysm with coils, leading to persistent expansion of the residual sac. Although an endovascular approach could represent a valid alternative for high-risk patients, surgical treatment remains the standard.…”

“…7) Rupture of a pseudoaneurysm in the gastrointestinal tract is a life-threatening event that is associated with a mortality rate of approximately 75% to 90%. 2,6) The pathogenesis of hepatic artery pseudoaneurysms is not well understood. Pancreatitis, abdominal trauma, and iatrogenic causes (e.g., prior abdominal surgery or endovascular interventions) have been reported as risk factors for hepatic artery pseudoaneurysm.…”

“…4) Because of the development of imaging techniques and percutaneous procedures, there are many reports of successful endovascular treatment and low morbidity and mortality. 1,2,[6][7][8] On the other hand, there is a large study describing the management of hepatic artery aneurysm. It showed that endovascular treatment carries mortality and success rates similar to those of operative strategies.…”