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Arterial embolization for bleeding pseudocysts complicating chronic pancreatitis
L P Gambiez1, O J Ernst, O A Merlier
1Clinique Chirurgicale Ouest, Hôpital Claude Huriez, Centre Hospitalier Regional Universitaire de Lille, France.
Archives of Surgery (Chicago, Ill. : 1960)
|September 25, 1997
Summary
Arterial embolization (EMB) effectively manages bleeding pancreatic pseudocysts and pseudoaneurysms. Successful EMB reduces the need for secondary surgery, though complications can occur, highlighting the importance of radiologist expertise.
Area of Science:
- Interventional Radiology
- Gastroenterology
- Vascular Surgery
Background:
- Bleeding pancreatic pseudocysts and pseudoaneurysms are serious complications of chronic pancreatitis.
- Management often involves complex interventions due to the high risk of mortality.
Purpose of the Study:
- To evaluate the efficacy of arterial embolization (EMB) for bleeding pancreatic pseudocysts/pseudoaneurysms.
- To assess the indications for secondary surgery after EMB.
Main Methods:
- Retrospective review of 14 patients with bleeding pancreatic pseudocysts/pseudoaneurysms.
- Celiac and superior mesenteric angiography with attempted arterial embolization.
- Mean follow-up of 60 months.
Main Results:
- Arterial EMB was successful in 11 of 14 patients, with 3 failures requiring surgery (1 death).
- Complications of EMB included duodenal necrosis and aortic thrombosis (1 death).
- Of 10 patients with stopped bleeding, 4 underwent pancreatectomy; the rest did not require further surgery.
Conclusions:
- Arterial EMB is an effective immediate treatment for bleeding pancreatic pseudocysts/pseudoaneurysms.
- Successful EMB can obviate the need for secondary surgery, particularly in patients with unfavorable conditions.
- Further surgery should be reserved for patients in good general condition with complications not treatable by minimally invasive methods.