Improved outcomes in postoperative and pancreatitis-related visceral pseudoaneurysms

Nicholas Zyromski, Carlos Vieira, Michael Stecker, Attila Nakeeb, Henry A. Pitt, Keith D. Lillemoe, Thomas Howard

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Pseudoaneurysm (PSA) of the visceral arterial tree is an uncommon but highly lethal complication of pancreatic surgery and pancreatitis. Surgical and angiographic interventions are used in treatment; however, optimal therapy remains unclear. We hypothesized that the natural history of PSA is different in these discrete clinical settings. From 1995-2005, 37 patients with PSA were treated: 13 after pancreatic surgery and 24 in the setting of pancreatitis. Postoperative patients most frequently presented with bleeding (92%), either from the gastrointestinal (GI) tract or a surgical drain. In this group, the diagnosis was most commonly made by angiography (77%), and 62% had a pancreatic fistula. In patients with pancreatitis, abdominal pain was the only presenting symptom in 62%, and GI bleeding was present in 29%. Eighty-seven percent had an associated pseudocyst or fluid collection. Interventional radiologic therapy successfully arrested hemorrhage in all 35 patients in whom it was employed. There were four false negative angiograms, and two patients required repeated interventions for rebleeding. The overall mortality was 14%. Pseudoaneurysms present differently in these two clinical settings, but transcatheter intervention is the first treatment of choice in clinically stable patients. Early recognition and prompt angiographic occlusion leads to improved outcomes.

Original languageEnglish
Pages (from-to)50-55
Number of pages6
JournalJournal of Gastrointestinal Surgery
Volume11
Issue number1
DOIs
StatePublished - Jan 2007

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False Aneurysm
Pancreatitis
Hemorrhage
Angiography
Pancreatic Fistula
Therapeutics
Abdominal Pain
Gastrointestinal Tract
Mortality

Keywords

  • Angiography
  • Pancreatic surgery
  • Pancreatitis
  • Pseudoaneurysm

ASJC Scopus subject areas

  • Surgery

Cite this

Improved outcomes in postoperative and pancreatitis-related visceral pseudoaneurysms. / Zyromski, Nicholas; Vieira, Carlos; Stecker, Michael; Nakeeb, Attila; Pitt, Henry A.; Lillemoe, Keith D.; Howard, Thomas.

In: Journal of Gastrointestinal Surgery, Vol. 11, No. 1, 01.2007, p. 50-55.

Research output: Contribution to journalArticle

Zyromski, Nicholas ; Vieira, Carlos ; Stecker, Michael ; Nakeeb, Attila ; Pitt, Henry A. ; Lillemoe, Keith D. ; Howard, Thomas. / Improved outcomes in postoperative and pancreatitis-related visceral pseudoaneurysms. In: Journal of Gastrointestinal Surgery. 2007 ; Vol. 11, No. 1. pp. 50-55.
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