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Successful treatment of a common hepatic artery pseudoaneurysm using a coronary covered stent following pancreatoduodenectomy: report of a case

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Abstract

This report presents the case of a common hepatic artery (CHA) pseudoaneurysm secondary to postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD), which was successfully treated using a coronary covered stent. A 70-year-old female underwent subtotal stomach-preserving PD for middle cholangiocarcinoma. POPF was identified on postoperative day (POD) 7, and the patient suddenly lost 500 ml of blood via the abdominal drain on POD 19. Urgent celiac arteriography revealed a CHA pseudoaneurysm. A coronary covered stent was placed to prevent rupture of the pseudoaneurysm and to maintain hepatic arterial flow, instead of performing transarterial embolization. No vascular adverse events were encountered during or after the procedure. Computed tomography and angiography showed a patent stent graft and good hepatic arterial flow 9 months after placement of the stent. Endovascular stent-graft placement not only treated the pseudoaneurysm, but also preserved the arterial blood flow. This report describes the placement of a covered stent graft for delayed hemorrhage after PD.

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References

  1. Buchler MW, Wagner M, Schmied BM, Uhl W, Friess H, Z’graggen K. Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy. Arch Surg. 2003;138:1310–5.

    Article  PubMed  Google Scholar 

  2. Nakao A, Takeda S, Inoue S, Nomoto S, Kanazumi N, Sugimoto H, et al. Indications and techniques of extended resection for pancreatic cancer. World J Surg. 2006;30:976–84.

    Article  PubMed  Google Scholar 

  3. DeOliveira ML, Winter JM, Schafer M, Cunningham SC, Cameron JL, Yeo CJ, et al. Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg. 2006;244:931–9.

    Article  PubMed  Google Scholar 

  4. Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, et al. 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg. 2006;10:1199–211.

    Article  PubMed  Google Scholar 

  5. Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, et al. Postpancreatectomy hemorrhage (PPH): an international study group of pancreatic surgery (ISGPS) definition. Surgery. 2007;142:20–5.

    Article  PubMed  Google Scholar 

  6. de Castro SM, Kuhlmann KF, Busch OR, van Delden OM, Lameris JS, van Gulik TM, et al. Delayed massive hemorrhage after pancreatic and biliary surgery: embolization or surgery? Ann Surg. 2005;241:85–91.

    PubMed  Google Scholar 

  7. Tien YW, Lee PH, Yang CY, Ho MC, Chiu YF. Risk factors of massive bleeding related to pancreatic leak after pancreaticoduodenectomy. J Am Coll Surg. 2005;201:554–9.

    Article  PubMed  Google Scholar 

  8. Yekebas EF, Wolfram L, Cataldegirmen G, Habermann CR, Bogoevski D, Koenig AM, et al. Postpancreatectomy hemorrhage: diagnosis and treatment: an analysis in 1669 consecutive pancreatic resections. Ann Surg. 2007;246:269–80.

    Article  PubMed  Google Scholar 

  9. Ding X, Zhu J, Zhu M, Li C, Jian W, Jiang J, et al. Therapeutic management of hemorrhage from visceral artery pseudoaneurysms after pancreatic surgery. J Gastrointest Surg. 2011;15:1417–25.

    Article  PubMed  Google Scholar 

  10. Otah E, Cushin BJ, Rozenblit GN, Neff R, Otah KE, Cooperman AM. Visceral artery pseudoaneurysms following pancreatoduodenectomy. Arch Surg. 2002;137:55–9.

    Article  PubMed  Google Scholar 

  11. Finley DS, Hinojosa MW, Paya M, Imagawa DK. Hepatic artery pseudoaneurysm: a report of seven cases and a review of the literature. Surg Today. 2005;35:543–7.

    Article  PubMed  Google Scholar 

  12. Sugimoto H, Kaneko T, Ishiguchi T, Takai K, Ohta T, Yagi Y, et al. Delayed rupture of a pseudoaneurysm following pancreatoduodenectomy: report of a case. Surg Today. 2001;31:932–5.

    Article  CAS  PubMed  Google Scholar 

  13. Makowiec F, Riediger H, Euringer W, Uhl M, Hopt UT, Adam U. Management of delayed visceral arterial bleeding after pancreatic head resection. J Gastrointest Surg. 2005;9:1293–9.

    Article  PubMed  Google Scholar 

  14. McGraw JK, Patzik SB, Gale SS, Dodd JT, Boorstein JM. Autogenous vein-covered stent for the endovascular management of a superior mesenteric artery pseudoaneurysm. J Vasc Interv Radiol. 1998;9:779–82.

    Article  CAS  PubMed  Google Scholar 

  15. Mansueto G, D’Onofrio M, Iacono C, Rozzanigo U, Serio G, Procacci C. Gastroduodenal artery stump haemorrhage following pylorus-sparing whipple procedure: treatment with covered stents. Dig Surg. 2002;19:237–40.

    Article  PubMed  Google Scholar 

  16. Harvey J, Dardik H, Impeduglia T, Woo D, DeBernardis F. Endovascular management of hepatic artery pseudoaneurysm hemorrhage complicating pancreaticoduodenectomy. J Vasc Surg. 2006;43:613–7.

    Article  PubMed  Google Scholar 

  17. Wallace MJ, Choi E, McRae S, Madoff DC, Ahrar K, Pisters P. Superior mesenteric artery pseudoaneurysm following pancreaticoduodenectomy: management by endovascular stent-graft placement and transluminal thrombin injection. Cardiovasc Intervent Radiol. 2007;30:518–22.

    Article  PubMed  Google Scholar 

  18. Kaw LL Jr, Saeed M, Brunson M, Delaria GA, Dilley RB. Use of a stent graft for bleeding hepatic artery pseudoaneurysm following pancreaticoduodenectomy. Asian J Surg. 2006;29:283–6.

    Article  PubMed  Google Scholar 

  19. Stoupis C, Ludwig K, Inderbitzin D, Do DD, Triller J. Stent grafting of acute hepatic artery bleeding following pancreatic head resection. Eur Radiol. 2007;17:401–8.

    Article  PubMed  Google Scholar 

  20. Heiss P, Bachthaler M, Hamer OW, Piso P, Herold T, Schlitt HJ, et al. Delayed visceral arterial hemorrhage following whipple’s procedure: minimally invasive treatment with covered stents. Ann Surg Oncol. 2008;15:824–32.

    Article  PubMed  Google Scholar 

  21. Sasaki K, Ueda K, Nishiyama A, Yoshida K, Sako A, Sato M, et al. Successful utilization of coronary covered stents to treat a common hepatic artery pseudoaneurysm secondary to pancreatic fistula after whipple’s procedure: report of a case. Surg Today. 2009;39:68–71.

    Article  PubMed  Google Scholar 

  22. Frego M, Bertin M, Brolese A, Ragazzi R, Ruffolo C, D’Amico DF. Endovascular treatment of acute pseudoaneurysm associated to pancreaticoduodenectomy. Hepatogastroenterology. 2009;56:1738–41.

    PubMed  Google Scholar 

  23. Hankins D, Chao S, Dolmatch BL, Jeyarajah RD. Covered stents for late postoperative arterial hemorrhage after pancreaticoduodenectomy. J Vasc Interv Radiol. 2009;20:407–9.

    Article  PubMed  Google Scholar 

  24. Suzuki K, Mori Y, Komada T, Matsushima M, Ota T, Naganawa S. Stent-graft treatment for bleeding superior mesenteric artery pseudoaneurysm after pancreaticoduodenectomy. Cardiovasc Intervent Radiol. 2009;32:762–6.

    Article  PubMed  Google Scholar 

  25. Tanaka K, Ohigashi H, Takahashi H, Gotoh K, Yamada T, Miyashiro I, et al. Successful embolization assisted by covered stents for a pseudoaneurysm following pancreatic surgery. World J Gastrointest Surg. 2010;2:295–8.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Wang MQ, Liu FY, Duan F, Wang ZJ, Song P, Fan QS. Stent-grafts placement for treatment of massive hemorrhage from ruptured hepatic artery after pancreaticoduodenectomy. World J Gastroenterol. 2010;16:3716–22.

    Article  PubMed  Google Scholar 

  27. Herzog T, Suelberg D, Belyaev O, Uhl W, Seemann M, Seelig MH. Treatment of acute delayed visceral hemorrhage after pancreatic surgery from hepatic arteries with covered stents. J Gastrointest Surg. 2011;15:496–502.

    Article  PubMed  Google Scholar 

  28. Limongelli P, Khorsandi SE, Pai M, Jackson JE, Tait P, Tierris J, et al. Management of delayed postoperative hemorrhage after pancreaticoduodenectomy: a meta-analysis. Arch Surg. 2008;143:1001–7.

    Article  PubMed  Google Scholar 

  29. Carr JA, Cho JS, Shepard AD, Nypaver TJ, Reddy DJ. Visceral pseudoaneurysms due to pancreatic pseudocysts: rare but lethal complications of pancreatitis. J Vasc Surg. 2000;32:722–30.

    Article  CAS  PubMed  Google Scholar 

  30. Reber PU, Baer HU, Patel AG, Wildi S, Triller J, Buchler MW. Superselective microcoil embolization: treatment of choice in high-risk patients with extrahepatic pseudoaneurysms of the hepatic arteries. J Am Coll Surg. 1998;186:325–30.

    Article  CAS  PubMed  Google Scholar 

  31. Sato N, Yamaguchi K, Shimizu S, Morisaki T, Yokohata K, Chijiiwa K, et al. Coil embolization of bleeding visceral pseudoaneurysms following pancreatectomy: the importance of early angiography. Arch Surg. 1998;133:1099–102.

    CAS  PubMed  Google Scholar 

  32. Okuno A, Miyazaki M, Ito H, Ambiru S, Yoshidome H, Shimizu H, et al. Nonsurgical management of ruptured pseudoaneurysm in patients with hepatobiliary pancreatic diseases. Am J Gastroenterol. 2001;96:1067–71.

    Article  CAS  PubMed  Google Scholar 

  33. Gercken U, Lansky AJ, Buellesfeld L, Desai K, Badereldin M, Mueller R, et al. Results of the jostent coronary stent graft implantation in various clinical settings: procedural and follow-up results. Catheter Cardiovasc Interv. 2002;56:353–60.

    Article  PubMed  Google Scholar 

Download references

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None of the authors has any conflicts of interest to declare. All authors certify that they have no commercial associations with any products mentioned in the manuscript

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Correspondence to Koji Asai.

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Asai, K., Watanabe, M., Kusachi, S. et al. Successful treatment of a common hepatic artery pseudoaneurysm using a coronary covered stent following pancreatoduodenectomy: report of a case. Surg Today 44, 160–165 (2014). https://doi.org/10.1007/s00595-012-0314-6

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  • DOI: https://doi.org/10.1007/s00595-012-0314-6

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