Pancreaticoduodenal artery pseudoaneurysm embolization

Area of Science:

• Interventional Radiology
• Gastroenterology
• Vascular Surgery

Background:

• Pancreatic pseudocysts can erode into adjacent vessels, leading to pseudoaneurysms (PSAs).
• PSAs pose a significant risk of hemorrhage, particularly in patients with chronic pancreatitis and duodenal pathology.
• Management of PSAs requires precise diagnosis and effective treatment to prevent life-threatening bleeding.

Observation:

• A 55-year-old male with a history of alcohol abuse, chronic pancreatitis, and duodenal ulcers presented with severe epigastric pain.
• Endoscopy revealed duodenal narrowing and ulceration; CT showed an enlarged pancreas head with calcifications and a cystic formation.
• Selective angiography identified a pancreaticoduodenal artery pseudoaneurysm and severe stenosis of the celiac trunk and hepatic artery.

Findings:

• Transcatheter arterial embolization using fiber coils successfully occluded the pancreaticoduodenal artery pseudoaneurysm.
• The procedure was performed despite high-grade stenosis of the celiac trunk and hepatic artery.
• No complications occurred post-embolization.

Implications:

• Transcatheter arterial embolization is a safe and effective treatment for pancreaticoduodenal artery pseudoaneurysms, even in complex cases.
• This minimally invasive approach offers a valuable alternative to surgery for managing PSA complications in patients with pancreatitis.
• Successful embolization led to a favorable long-term outcome for the patient, highlighting its clinical utility.