Vascular Complications in Patients With Pancreatic Walled-Off Necrosis-A Retrospective, Single Cohort Study

Acute pancreatitis (AP) may lead to the development of pancreatic walled-off necrosis (WON) and vascular complications. We analyzed the frequency of vascular complications and their clinical impact in patients with WON.

The development of bleeding and splanchnic venous thrombosis (SVT) was assessed in a retrospective, single cohort of 290 patients undergoing invasive treatment for symptomatic WON. Bleeding was defined as nonprocedure-related requiring transfusion, embolization, or surgery, whereas SVT was defined as the presence of a thrombus in one of the splanchnic veins on contrast-enhanced computed tomography.

In total, 78 patients (27%) developed 87 vascular complications. Forty-four patients (15%) developed SVT, 25 patients (9%) bleeding, and 9 patients (3%) developed both. At the time of the index intervention, 44 patients (83%) had already developed SVT, and only 7 episodes of bleeding had occurred (21%). Patients with bleeding had a greater need for intensive care unit treatment and their in-hospital mortality was higher than patients without bleeding (59% vs 38%, P = 0.003 and 38% vs 13%, P < 0.0001, respectively).

Vascular complications are common in WON patients, but only bleeding is associated with increased morbidity and in-hospital mortality. Most SVT occur before an index intervention, while bleeding episodes primarily occur afterwards.