ABSTRACT
CONTEXT: Pseudoaneurysms associated with pancreatitis are rare, and bleeding pseudoaneurysms are associated with a high mortality. OBJECTIVE: The aim of this study was to report the outcomes of endovascular and percutaneous therapy in the management of pseudoaneurysms secondary to pancreatitis. PATIENTS: Patients who underwent angiography for pseudoaneurysms associated with pancreatitis from 2005 to 2011 were identified from the angiography database. MAIN OUTCOME MEASURES: Patient demographics, clinical presentation, radiological findings, treatment, and outcomes were retrospectively reviewed. RESULTS: Nineteen pseudoaneurysms associated with pancreatitis in 13 patients were identified. The diagnosis of a pseudoaneurysm was made by computerised tomography angiography in seven patients, followed by portal venous phase contrast enhanced CT (n=4), duplex ultrasound (n=1) and angiography (n=1). At angiography, coil embolisation was attempted in 11 patients with an initial success rate of 82% (n=9). One patient underwent successful embolisation with percutaneous thrombin injection. The recurrence rate following initial successful embolisation was 11% (n=1). There were no episodes of re-bleeding following embolisation but re-bleeding following thrombin injection was observed in one case. The morbidity and mortality rate in the 12 patients that were successfully treated was 25% (n=3) and 8% (n=1), respectively. All 12 patients that were successfully treated demonstrated radiological resolution of their pseudoaneurysms, with a median follow-up of 20 months. CONCLUSION: Endovascular embolisation is a suitable first-line management strategy associated with low recurrence rates. The role of percutaneous thrombin injection is yet to be defined.
Subject(s)
Aneurysm, False/therapy , Pancreatitis/complications , Adult , Aged , Aged, 80 and over , Aneurysm, False/diagnostic imaging , Aneurysm, False/mortality , Angiography , Embolization, Therapeutic , Female , Humans , Male , Middle Aged , Pancreatitis/diagnosis , Recurrence , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Graft thrombosis rates after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms vary widely in published series. When thrombosis does occur, it usually involves a single limb and occurs within 3 months of stent-graft insertion. If the entire endoprosthesis is thrombosed, treatment may be challenging because femoro-femoral crossover graft insertion is not an option and a greater volume of thrombus is present, thus making thrombolysis more difficult. We present two cases of delayed thrombosis after EVAR involving the entire stent-graft. These were successfully treated by a combined surgical and endovascular technique, and patency has been maintained in both cases to date.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis , Endovascular Procedures/methods , Graft Occlusion, Vascular/diagnosis , Graft Occlusion, Vascular/surgery , Stents , Venous Thrombosis/surgery , Aged , Femoral Artery/diagnostic imaging , Femoral Artery/surgery , Follow-Up Studies , Humans , Iliac Artery/diagnostic imaging , Male , Middle Aged , Tomography, X-Ray Computed/methods , Treatment Outcome , Ultrasonography, Doppler, Duplex/methods , Vascular Patency , Venous Thrombosis/diagnosisABSTRACT
This report describes an incidental finding of a pseudoaneurysm of the abdominal aorta on a computed tomography (CT) renal angiogram during investigation of chronic renal failure in a 73-year-old man. The patient had undergone a translumbar aortogram 20 years previously. An increase in the size of the aneurysm by 7 mm over 6 months prompted treatment and the aneurysm underwent successful endovascular repair with a custom-made stent-graft.
Subject(s)
Aneurysm, False/etiology , Aneurysm, False/surgery , Aortic Aneurysm, Abdominal/etiology , Aortic Aneurysm, Abdominal/surgery , Stents , Vascular Surgical Procedures , Aged , Aneurysm, False/diagnostic imaging , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortography , Blood Vessel Prosthesis Implantation , Humans , Kidney Failure, Chronic/diagnostic imaging , Male , Tomography, X-Ray ComputedABSTRACT
PURPOSE: To classify and analyze the volumetric changes seen on spiral computed tomographic angiography (CTA) following endovascular abdominal aortic aneurysm (AAA) repair. METHODS: Fifty patients (46 men; mean age 71 years, range 51-83) with >1 year of imaging follow-up were retrospectively selected. The volume of the aneurysm sac was calculated on standard CT workstations to obtain plots of volume changes over time. For the purpose of this study, a 10% change in sac volume was considered significant. RESULTS: Over a mean 32-month follow-up, 256 CTA scans were performed; initial mean sac volume was 259 mL and initial mean AAA diameter was 6.5 cm. Six distinct patterns of volume change were recognized: group Ia (28 patients, 56%): progressive reduction in aneurysm sac volume; group Ib (3 patients, 6%): transient initial increase then same as Ia; group II (4 patients, 8%): no significant change; group IIIa (5 patients, 10%): late increase in volume; group IIIb (8 patients, 16%): progressive increase in volume; and group IV (2 patients, 4%): late reduction in volume after secondary intervention. Group III changes were associated with endoleak types I and III (p<0.0001). CONCLUSIONS: This classification system of spiral CTA volumetric changes features 6 patterns with recognized clinical significance and predictive value for endoleaks. Group I is the ideal outcome when the aneurysm sac shrinks and often completely disappears, while group III is associated with types I and type III endoleak and should prompt further investigation. Long-term volumetric analysis of all patients is advised.
