Vascular complications of chronic pancreatitis: A tertiary center experience

Anand, Abhinav; Gunjan, Deepak; Agarwal, Samagra; Kaushal, Kanica; Sharma, Shivam; Gopi, Srikanth; Mohta, Srikant; Madhusudhan, Kumble Seetharama; Singh, Namrata; Saraya, Anoop

doi:10.1016/j.pan.2020.07.005

Cited by 10 publications

(14 citation statements)

References 35 publications

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“…Furthermore, it is possible that older studies overestimate the frequency of variceal bleeding due to a limited availability of diagnostic tools [13]. Alcohol consumption and pseudocysts were risks factors for vascular events in our study, confirming previous reports [8,9,13]. The association between pseudocysts and splanchnic VT may be explained by the compression of the splenic vein as well as ongoing local inflammation [13].…”

Section: Discussionsupporting

confidence: 86%

“…However, a low rate of bleeding was reported in a study from the USA, whose experience suggested that gastric variceal bleeding in pancreatitis-induced splenic vein thrombosis was uncommon (4%) [8]. Even a recently published study from India showed a low occurrence of gastrointestinal bleeding (3.5%), suggesting the presence of collaterals as a reducing factor for bleeding [9]. That is in line with our results since 83.3% of patients developed abdominal collateral vessels, which could explain the absence of variceal bleeding and a low necessity of endoscopic interventions in our cohort during the follow-up (median follow up time since the occurrence of vascular event was 4.2 years).…”

Section: Discussionmentioning

confidence: 97%

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Vascular Complications in Patients with Chronic Pancreatitis

Vujasinović

Dugic

Nouri

et al. 2021

JCM

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Introduction: Chronic pancreatitis (CP) is a long-standing progressive inflammation of the pancreas, which can lead to a variety of vascular complications, such as splanchnic venous thrombosis (VT) and arterial pseudoaneurysm (PA). There is a lack of studies on vascular complications in Scandinavian countries. Methods: We performed a retrospective analysis of medical records of patients with CP identified from the Karolinska University Hospital database between 2003 and 2018. A total of 394 patients with definite CP were included in the study. Results: There were 33 patients with vascular complications, with a median age of 62 (IQR 55–72) years. The cumulative incidence of vascular events was 3.2% at 5 years. Thirty patients had isolated VT, whereas three patients had PA (7.6% and 0.8%, respectively). Isolated splenic vein thrombosis was most common (53.3%), followed by a combination with other splanchnic veins. PA was found in the splenic artery in two patients and in the left gastric artery in one patient. Varices were present in three (10%) patients; variceal bleeding was not recorded. All patients had asymptomatic splanchnic VT, most with chronic VT with developed collaterals (83.3% had abdominal collateral vessels). Nearly two-thirds of patients with VT (63.3%) received no treatment, whereas 11 (36.6%) were treated with anticoagulants. Pseudocysts and alcoholic etiology of CP are risk factors for vascular complications. Conclusions: The cumulative incidence of vascular complications was 3.2% at 5 years. Splanchnic VT is more common than PA. Patients were asymptomatic with no variceal bleeding, explained by well-developed collateral vessels and strong study inclusion criteria.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 97%

Vascular Complications in Patients with Chronic Pancreatitis

Vujasinović

Dugic

Nouri

et al. 2021

JCM

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“…Alcoholic CP was the most significant predictor for the development of pseudoaneurysm, followed by the presence of pseudocyst. [15] Review of the literature revealed that the incidence of common hepatic artery injury is much higher than proper hepatic artery and right or left hepatic artery. Generally, the artery is closer to the pancreas, the arterial injury is more likely to occur.…”

Section: Discussionmentioning

confidence: 99%

“…Alcoholic CP was the most significant predictor for the development of pseudoaneurysm, followed by the presence of pseudocyst. [ 15 ]…”

Section: Discussionmentioning

confidence: 99%

Hepatic artery pseudoaneurysm caused by chronic pancreatitis: Case report and literature review

Jia

Zhu

et al. 2023

Medicine

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Rationale: Visceral artery pseudoaneurysm is a rare complication of chronic pancreatitis (CP), all pancreatic or peripancreatic arteries have been reported to be involved, while hepatic artery is less common. Patient concerns: This case report illustrated a 42-year-old man with CP who developed right hepatic artery pseudoaneurysm (HAP), and finally he was treated with intravascular embolization. Diagnoses: The patient suffered from HAP due to acute attack of CP. Interventions: The pseudoaneurysm located in a fine branch of right hepatic artery was embolized. Outcomes: The HAP of the patient was cured. He had no recurrent bloody stool or abdominal pain. The symptoms gradually relieved. Conclusion: Herein, we report a patient with CP who developed right HAP causing infected hematoma, gastrointestinal bleeding, and obstructive jaundice, and a literature review is also presented. HAP caused by CP is a rare disease in the clinic, but rupture of pseudoaneurysm is fatal. Careful evaluation, early detection, and prompt treatment should be performed when the patient is admitted and followed up.

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“…VT is a more frequent complication than pseudoaneurysm. It has strong associations with alcoholic chronic pancreatitis, pseudocyst, and the presence of an inflammatory head mass [ 2 ]. Although pharmacological management is the first-line treatment for recanalization of acute portal vein thromboses, treating a chronic long segment portal vein thrombosis (PVT) is always challenging, especially when there is a cavernomatous transformation along with portal hypertensive complications such as variceal bleeding and ascites.…”

Section: Introductionmentioning

confidence: 99%

Successful use of a mesocaval shunt to treat refractory ascites in a chronic pancreatitis induced portal vein thrombosis

Dutta

Pal

Ram

et al. 2022

Ann Hepatobiliary Pancreat Surg

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The state of intense peripancreatic inflammation in chronic pancreatitis can give rise to various vascular complications such as venous thrombosis and arterial pseudoaneurysms. Due to its intimate location with the pancreas, spleno-mesenteric-portal axis suffers the greatest blunt of thrombotic complications. Treatment modalities for such cases of chronic portal vein thrombosis have always been controversial and challenging. Medical management with anticoagulants is both risky and unsatisfactory due to presence of varices, hypersplenism, and persistence of the inflammatory pathology. Although endovascular techniques have been tried in various case reports, there are definite anatomical challenges in cases of long segment porto-mesenteric thrombosis with massive ascites. Surgical shunts have been historically described for cirrhotic and non-cirrhotic portal hypertensive patients. However, its use in patients with refractory ascites due to chronic pancreatitis induced portal vein thrombosis has not been reported in the medical literature. Here, we present a case of an extensive portal vein thrombosis with massive refractory ascites in a patient with alcohol-induced chronic pancreatitis successfully treated with a surgical mesocaval shunt using an interposition small diameter graft.

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Vascular complications of chronic pancreatitis: A tertiary center experience

Cited by 10 publications

References 35 publications

Vascular Complications in Patients with Chronic Pancreatitis

Vascular Complications in Patients with Chronic Pancreatitis

Hepatic artery pseudoaneurysm caused by chronic pancreatitis: Case report and literature review

Successful use of a mesocaval shunt to treat refractory ascites in a chronic pancreatitis induced portal vein thrombosis

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