Endovascular treatment of visceral aneurysms associated with pancreatitis and a suggested classification with therapeutic implications.
OBJECTIVE
To describe a 10-year experience of endovascular and percutaneous treatment of aneurysms and pseudoaneurysms complicating pancreatitis, and to analyze this experience and propose a classification based on computed tomography (CT) and angiographic findings that has therapeutic implications. This may reduce the rate of recurrent bleeding after surgery or endovascular treatment.


METHODS
Twenty-three patients with aneurysms or pseudoaneurysms associated with acute pancreatitis were treated by endovascular or percutaneous methods. All underwent CT and angiography. The early development of a simple classification based on the CT and angiographic findings was used to guide treatment decisions. In accordance with this classification, 19 patients were treated by primary coil embolization and four were treated by primary percutaneous thrombin injection.


RESULTS
Among the 19 patients treated by primary coil embolization, there were two early recurrences of the pseudoaneurysm. All four patients treated by percutaneous thrombin injection exhibited late recurrences and were successfully treated by percutaneous thrombin injections. Twenty-one patients (91.3%) were alive at 6 months.


CONCLUSIONS
Endovascular and percutaneous treatment of aneurysms and pseudoaneurysms complicating pancreatitis is safe and effective and is associated with good outcomes, but careful follow-up is necessary. The decision of which treatment option is most appropriate can be made in accordance with a classification based on CT and angiographic appearance.
Nicholson
Anthony A
AA
Radiology Department, Leeds Teaching Hospitals, Great George Street, Leeds LS1 3EX, United Kingdom. tony.nicholson@leedsth.nhs.uk
Patel
Jai
J
McPherson
Simon
S
Shaw
David R
DR
Kessel
David
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D017541:Aneurysm, False / Q000628:therapy; D000792:Angiography; D019091:Critical Pathways; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D018579:Patient Selection; D012189:Retrospective Studies; D013917:Thrombin / Q000008:administration & dosage / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014781:Viscera / Q000098:blood supply*
D013917:Thrombin