Successful treatment of pseudoaneurysms of celiac and superior mesenteric arteries by combined endovascular and surgical approach.
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.
Saito
Takuro
T
First Department of Surgery, Faculty of Medicine, Fukushima Medical University, 1-Hikarigaoka, Fukushima 960-1295, Japan.
Tsuchiya
Takao
T
Kenjo
Akira
A
Kimura
Takashi
T
Sato
Yoshihiro
Y
Saito
Takaharu
T
Anazawa
Takayuki
T
Takase
Shinya
S
Satokawa
Hirono
H
Satoh
Youichi
Y
Yokoyama
Hitoshi
H
Ohira
Hiromasa
H
Rai
Tsuyoshi
T
Gotoh
Mitsukazu
M
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