Arterial embolization for bleeding pseudocysts complicating chronic pancreatitis.
OBJECTIVE
To evaluate the efficacy of arterial embolization (EMB) in the management of bleeding pancreatic pseudocysts or pseudoaneurysms and to assess the possible indication for secondary surgery.


METHODS
Retrospective review with a mean follow-up of 60 months (range, 18-125 months).


METHODS
Tertiary care center, university hospital.


METHODS
The medical records of 14 patients who were referred to the hospital with bleeding pancreatic pseudocysts and/or pseudoaneurysms related to chronic pancreatitis, between 1983 and 1994, were reviewed. The clinical presentation was major bleeding in 10 patients (gastrointestinal or intraperitoneal) and chronic signs in 4.


METHODS
Celiac and superior mesenteric angiography with EMB attempt in all patients.


METHODS
The immediate effect on bleeding and the long-term safety of arterial EMB.


RESULTS
Embolization failed in 3 patients and surgery was needed (1 patient died). Embolization was successful in 11 patients, but 2 complications occurred (duodenal necrosis and aortic thrombosis) (1 patient died). Among the 10 patients whose bleeding stopped, an intentional pancreatectomy was performed 4 times (all patients are alive). The 6 other patients did not undergo a further pancreatic operation due to unfavorable local or general condition. None of them had recurrent bleeding, 3 of them died later of extrapancreatic diseases. Overall, early mortality was 14%, with deaths occurring only in unsuccessful or complicated EMB cases.


CONCLUSIONS
The immediate effectiveness of arterial EMB is undeniable but depends on the expertise of the radiologist. When EMB is successful, further surgery should be reserved for patients in good general condition who have other complications of chronic pancreatitis that are not amenable to minimally invasive techniques.
Gambiez
L P
LP
Clinique Chirurgicale Ouest, Hôpital Claude Huriez, Centre Hospitalier Regional Universitaire de Lille, France.
Ernst
O J
OJ
Merlier
O A
OA
Porte
H L
HL
Chambon
J P
JP
Quandalle
P A
PA
D000328:Adult; D017541:Aneurysm, False / Q000150:complications / Q000401:mortality / Q000628:therapy; D001158:Arteries; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000150:complications / Q000401:mortality / Q000628:therapy*; D010195:Pancreatitis / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome