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Transcatheter microcoil embolotherapy for ruptured pseudoaneurysm following pancreatic and biliary surgery
Toshiya Shibata1, Tadashi Sagoh, Fumie Ametani
1Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Shogoin, Sakyoku, Kyoto, 606-8507, Japan. ksj@kuhp.kyoto-u.ac.jp
Purpose:
To evaluate the outcome of transcatheter microcoil embolotherapy for bleeding pseudoaneurysms complicating major pancreatic and biliary surgery.
Materials And Methods:
Over an 8-year period, 8 patients were encountered who developed massive bleeding from pseudoaneurysms 15-64 days (mean 31 days) following major pancreatic and biliary surgery. Urgent transcatheter microcoil embolotherapy was performed in all 8 patients.
Results:
Transcatheter embolotherapy was successful in 7 of 8 patients (88%) but failed in one due to development of disseminated intravascular coagulation. One patient developed recurrent bleeding 36 days after the first embolotherapy from a newly developed pseudoaneurysm, which was again treated successfully with embolization. Two patients subsequently underwent additional surgery for residual pathology. Three of the 7 patients with successful embolotherapy were alive at 10-96 months, 4 patients died of associated malignancies 4-20 months after embolotherapy.
Conclusion:
Transcatheter microcoil embolotherapy is effective for bleeding pseudoaneurysms complicating pancreatic and biliary surgery, and should be considered the first treatment of choice.
Insights
Transcatheter microcoil embolotherapy effectively treats bleeding pseudoaneurysms after pancreatic and biliary surgery. This minimally invasive procedure is the recommended first-line treatment for these serious complications.
Area of Science:
- Interventional Radiology
- Vascular Surgery
- Gastroenterology
Background:
- Hemorrhage from pseudoaneurysms is a severe complication of major pancreatic and biliary surgery.
- Management of these bleeding pseudoaneurysms presents significant challenges.
Observation:
- Eight patients with massive bleeding from pseudoaneurysms post-surgery were treated with transcatheter microcoil embolotherapy.
- The mean time to pseudoaneurysm development was 31 days after surgery.
Findings:
- Successful embolotherapy was achieved in 88% of patients.
- One patient experienced recurrent bleeding from a new pseudoaneurysm, successfully re-treated.
- Long-term survival was influenced by underlying malignancies, not solely the embolotherapy outcome.
Implications:
- Transcatheter microcoil embolotherapy is a highly effective treatment for bleeding pseudoaneurysms.
- It should be considered the primary therapeutic option for these post-surgical complications.
- Further research may explore optimizing patient selection and long-term management strategies.