Risk factors for visceral artery pseudoaneurysm in chronic pancreatitis: A retrospective analysis

Chronic pancreatitis (CP) leads to enduring abdominal pain and functional insufficiency, alongside notable risks posed by vascular complications. Pseudoaneurysms (PSA) are common in CP, necessitate careful management due to potential life-threatening hemorrhage. Literature suggests a 5-10% incidence of gastrointestinal bleeding in CP, often related to PSA affecting nearby arteries. Our study aims to evaluate the prevalence and outcomes of vascular complications in CP, aiding in improved management strategies.

This retrospective observational study was conducted on the patients diagnosed with CP at a tertiary care center in Northeast India from April 2018 to December 2023. Demographic data and risk factors such as smoking and alcohol use were collected from medical records. The diagnosis and etiological assessment followed the M-ANNHEIM criteria, employing contrast-enhanced computed tomography.

In our study of 86 patients with CP, predominantly male (68.6%), the median age at presentation was 37.4 years. Arterial PSAs were identified in 11 patients (12.79%), with a median onset of 18.2 months from symptom onset. Univariate analysis revealed that male sex (p=0.015), alcohol abuse (p=0.001), smoking (p=0.035), pseudocyst formation (p=0.008), and absence of parenchymal calcification (p=0.002) were significantly associated with PSA development. Interestingly, inflammatory head mass was more prevalent in patients without PSA (49.3% vs. 9.1%, p=0.02), suggesting a potential protective effect. On multivariate analysis, independent predictors of PSA formation included an alcohol abuse [odds ratio (OR): 10.75, 95% confidence interval (CI): 0.967-119.53, p=0.05], a pseudocyst presence (OR: 27.41, 95% CI: 1.591-472.39, p=0.02), and a bulky pancreatic head (OR: 12.72, 95% CI: 2.97-54.51, p=0.0006), while parenchymal calcification remained inversely associated (OR: 0.1279, 95% CI: 0.016-1.02, p=0.05).

Arterial PSA formation in CP is independently associated with alcohol abuse, pseudocysts, and inflammatory head mass, while parenchymal calcification appears protective. Endovascular coiling has emerged as a promising intervention, demonstrating effective management of PSA and successful prevention of hemorrhagic complications.