Stent placement is effective on both postoperative hepatic arterial pseudoaneurysm and subsequent portal vein stricture: a case report.
To treat postoperative bleeding after hepato-pancreato-biliary surgery, interventional radiology has become essential. We report a case of coincidental pseudoaneurysm and jejunal varices that were both successfully treated by stent-grafts. After a pancreaticoduodenectomy, the patient developed a pseudoaneurysm in the hepatic artery and a stenosis in its periphery. After establishing hepatic arterial flow by placing stent-grafts over both the pseudoaneurysm and the stenosis, the pseudoaneurysm was embolized with microcoils. Nine months later, the patient developed jejunal varices caused by a severe stricture in the main trunk of the portal vein. Percutaneous transhepatic portography was performed and stent-grafts were placed over the stenotic segment. A venoplasty using stent-grafts normalized the portal blood flow and the jejunal varices vanished. Although stenosis occurred due to scarred tissues from leakage after pancreaticoduodenectomy, stent-grafts were useful for managing jejunal bleeding post-operatively.
Ichihara
Toshiaki
T
Department of Gastroenterological Surgery, Akita University School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan. ichihara@gipc.akita-u.ac.jp
Sato
Tsutomu
T
Miyazawa
Hideaki
H
Shibata
Satoshi
S
Hashimoto
Manabu
M
Ishiyama
Koichi
K
Yamamoto
Yuzo
Y
D017541:Aneurysm, False / Q000175:diagnosis / Q000601:surgery*; D000792:Angiography; D003251:Constriction, Pathologic / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery; D005260:Female; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D011169:Portal Vein / Q000502:physiology / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery; D011379:Prognosis; D012039:Regional Blood Flow / Q000502:physiology; D015607:Stents