title: Angiographic intervention in patients with a suspected visceral artery pseudoaneurysm complicating pancreatitis and pancreatic surgery.
abstract: OBJECTIVE
  To assess the clinical effectiveness of angiography and transcatheter intervention in patients suspected of visceral artery pseudoaneurysm complicating pancreatitis and pancreatic surgery.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  A total of 51 patients who underwent mesenteric angiography for a suspected visceral artery pseudoaneurysm following pancreatitis or pancreatic surgery from 1978 to 2010 were included in this study. There were 39 men and 12 women. The mean age was 66 years (range, 21-89 years) at the time of the angiography. Data on patients' demographics, medical history, angiographic findings, treatment, and outcomes were recorded. Of these 51 patients, 27 had acute pancreatitis, 22 had pancreatic cancer, and 2 experienced pancreatic trauma. Embolization was performed for patients with a pseudoaneurysm. One patient was treated with a stent graft.
  
  
  METHODS
  The technical success rate of the intervention, the 24-hour and 30-day rebleeding rates, and the 24-hour and 30-day mortality rates were calculated. A multivariate analysis was performed to determine the factors associated with survival following angiography.
  
  
  RESULTS
  Of the 51 patients studied, 23 had a visceral artery pseudoaneurysm involving the gastroduodenal (7 patients), hepatic (5 patients), splenic (5 patients), and other arteries (7 patients). The technical success rate of the intervention (ie, embolization or exclusion with a Stent graft) was 100%. The 24-hour and 30-day rebleeding rates were 4% and 17%, respectively. The 24-hour and 30-day mortality rates were 0% and 9%, respectively. For the 27 patients who had a negative angiographic finding, the 24-hour and 30-day rebleeding rates were 0% and 11%, respectively, and the 24-hour and 30-day mortality rates were 4% and 21%, respectively. The requirement of a large number of blood products prior to angiography was associated with poor outcome.
  
  
  CONCLUSIONS
  Embolization was highly effective in treating a pseudoaneurysm complicating pancreatitis and pancreatic surgery. The hemodynamic status at the time of angiography determines overall survival.
authors.affiliation: Department of Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. skalva@partners.org
authors.forename: Sanjeeva P
authors.initials: SP
authors.lastname: Kalva
authors.forename: Kalpana
authors.initials: K
authors.lastname: Yeddula
authors.forename: Stephan
authors.initials: S
authors.lastname: Wicky
authors.forename: Carlos
authors.initials: C
authors.lastname: Fernandez del Castillo
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Warshaw
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D000792:Angiography; D002406:Catheterization, Peripheral; D004621:Embolization, Therapeutic; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000293:injuries / Q000601:surgery*; D010195:Pancreatitis / Q000150:complications*; D011183:Postoperative Complications; D015641:Radiography, Interventional; D012008:Recurrence; D015607:Stents; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D014781:Viscera / Q000098:blood supply*; D055815:Young Adult