title: Successful treatment of pseudoaneurysms of celiac and superior mesenteric arteries by combined endovascular and surgical approach.
abstract: Pseudoaneurysm after pancreas resection poses serious complications, including rupture and hemorrhage. Here we report a case of delayed massive hemorrhage from celiac and superior mesenteric arteries, which was successfully treated with a combined endovascular and surgical approach. The patient was a 52-year-old man who presented with pseudoaneurysms of the celiac and superior mesenteric arteries after distal pancreatectomy. Following the detection of sentinel bleeding from the abdominal drain, emergency angiography of the celiac and superior mesenteric arteries revealed stenosis of the celiac artery and pseudoaneurysms in the superior mesenteric artery. We occluded these lesions with a platinum coil, using an interventional radiological technique combined with bypass grafting between the abdominal aorta and the SMA, using the saphenous vein. However, re-bleeding into the abdominal cavity occurred from the proximal SMA pseudoaneurysm. We inserted an endoluminal stent-graft into the abdominal aorta and completed bypass grafting between the aorta and bilateral renal arteries. The hemorrhage ceased and the postoperative course was uneventful. The patient was discharged 34 days after the treatment (149 days after the initial operation). In conclusion, this combined endovascular and surgical approach is feasible and seems appropriate for pseudoaneurysms arising from proximal sites in visceral arteries.
authors.affiliation: First Department of Surgery, Faculty of Medicine, Fukushima Medical University, 1-Hikarigaoka, Fukushima 960-1295, Japan.
authors.forename: Takuro
authors.initials: T
authors.lastname: Saito
authors.forename: Takao
authors.initials: T
authors.lastname: Tsuchiya
authors.forename: Akira
authors.initials: A
authors.lastname: Kenjo
authors.forename: Takashi
authors.initials: T
authors.lastname: Kimura
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sato
authors.forename: Takaharu
authors.initials: T
authors.lastname: Saito
authors.forename: Takayuki
authors.initials: T
authors.lastname: Anazawa
authors.forename: Shinya
authors.initials: S
authors.lastname: Takase
authors.forename: Hirono
authors.initials: H
authors.lastname: Satokawa
authors.forename: Youichi
authors.initials: Y
authors.lastname: Satoh
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yokoyama
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Ohira
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Rai
authors.forename: Mitsukazu
authors.initials: M
authors.lastname: Gotoh
mesh_terms: D017541:Aneurysm, False / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects; D010190:Pancreatic Neoplasms / Q000601:surgery; D011859:Radiography; D015642:Radiology, Interventional; D015607:Stents