title: Endovascular pseudoaneurysm repair after distal pancreatectomy with celiac axis resection.
abstract: Erosive hemorrhage due to pseudoaneurysm is one of the most life-threatening complications after pancreatectomy. Here, we report an extremely rare case of rupture of a pseudoaneurysm of the common hepatic artery (CHA) stump that developed after distal pancreatectomy with en block celiac axis resection (DP-CAR), and was successfully treated through covered stent placement. The patient is a 66-year-old woman who underwent DP-CAR after adjuvant chemoradiotherapy for locally advanced pancreatic body cancer. She developed an intra-abdominal abscess around the remnant pancreas head 31 d after the surgery, and computed tomography (CT) showed an occluded portal vein due to the spreading inflammation around the abscess. Her general condition improved after CT-guided drainage of the abscess. However, 19 d later, she presented with melena, and CT showed a pseudoaneurysm arising from the CHA stump. Because the CHA had been resected during the DP-CAR, this artery could not be used as the access route for endovascular treatment, and instead, we placed a covered stent via the inferior pancreaticoduodenal artery originating from the superior mesenteric artery. After stent placement, cessation of bleeding and anterograde hepatic artery flow were confirmed, and the patient recovered well without any further complications. CT angiography at the 6-mo follow-up indicated the patency of the covered stent with sustained hepatic artery flow. To our knowledge, this is the first reported case of endovascular repair of a pseudoaneurysm that developed after DP-CAR.
authors.affiliation: Tatsuaki Sumiyoshi, Yasuo Shima, Takehiro Okabayashi, Akihito Kozuki, Toshio Nakamura, Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi city, Kochi 781-8555, Japan.
authors.forename: Tatsuaki
authors.initials: T
authors.lastname: Sumiyoshi
authors.affiliation: Tatsuaki Sumiyoshi, Yasuo Shima, Takehiro Okabayashi, Akihito Kozuki, Toshio Nakamura, Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi city, Kochi 781-8555, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Shima
authors.affiliation: Tatsuaki Sumiyoshi, Yasuo Shima, Takehiro Okabayashi, Akihito Kozuki, Toshio Nakamura, Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi city, Kochi 781-8555, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Noda
authors.affiliation: Tatsuaki Sumiyoshi, Yasuo Shima, Takehiro Okabayashi, Akihito Kozuki, Toshio Nakamura, Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi city, Kochi 781-8555, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Hosoki
authors.affiliation: Tatsuaki Sumiyoshi, Yasuo Shima, Takehiro Okabayashi, Akihito Kozuki, Toshio Nakamura, Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi city, Kochi 781-8555, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hata
authors.affiliation: Tatsuaki Sumiyoshi, Yasuo Shima, Takehiro Okabayashi, Akihito Kozuki, Toshio Nakamura, Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi city, Kochi 781-8555, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Okabayashi
authors.affiliation: Tatsuaki Sumiyoshi, Yasuo Shima, Takehiro Okabayashi, Akihito Kozuki, Toshio Nakamura, Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi city, Kochi 781-8555, Japan.
authors.forename: Akihito
authors.initials: A
authors.lastname: Kozuki
authors.affiliation: Tatsuaki Sumiyoshi, Yasuo Shima, Takehiro Okabayashi, Akihito Kozuki, Toshio Nakamura, Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi city, Kochi 781-8555, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Nakamura
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D059186:Chemoradiotherapy, Adjuvant; D057510:Endovascular Procedures / Q000295:instrumentation; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008551:Melena / Q000175:diagnosis / Q000209:etiology; D017538:Mesenteric Artery, Superior / Q000473:pathology / Q000601:surgery; D009361:Neoplasm Invasiveness; D010180:Pancreatectomy / Q000009:adverse effects*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D013157:Splenic Artery / Q000473:pathology / Q000601:surgery; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
keywords: Covered stent; Distal pancreatectomy; En block celiac axis resection; Endovascular treatment; Pseudoaneurysm