ISSN: 1899-0967
Polish Journal of Radiology
Established by prof. Zygmunt Grudziński in 1926 Sun
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2018
vol. 83
 
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abstract:
Case report

Percutaneous puncture and embolisation for pancreatitis-related pseudoaneurysm: the feasibility of thrombin injection even in collection of fluid surrounding the pseudoaneurysm

Kenkichi Michimoto, Takahiro Higuchi, Keitaro Enoki, Yo Matsui, Shinsuke Takenaga, Chisato Saeki

© Pol J Radiol 2018; 83: e510-e513
Online publish date: 2018/12/05
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Purpose
Pancreatitis-related pseudoaneurysm, a potentially life-threatening condition, is treated utilising endovascular management as a first choice and alternatively by percutaneous direct puncture of the aneurysm and embolisation.

Case report
A 50-year-old man with alcohol-induced necrotic pancreatitis underwent transcatheter arterial embolisation (TAE) for multiple pancreatic pseudoaneurysms. TAE failed in one enlarged aneurysm in the pancreatic body, and percutaneous direct needle puncture and coagulation using thrombin was planned. Precise puncture of the aneurysmal sac under fluoroscopy and computed tomographic (CT) guidance failed, but we could inject about 500 units of thrombin through the outer cannula into the collection of fluid surrounding the aneurysm. Compared to preoperative images, contrast-enhanced CT (CECT) showed shrinkage of the pseudoaneurysm without complications just after the procedure and its disappearance five days after the procedure.

Conclusions
Percutaneous direct puncture and embolisation is a feasible choice to treat pancreatic pseudoaneurysms, and injection of thrombin even into the collection of fluid surrounding the pseudoaneurysm can be a viable alternative, especially in cases in which precise puncture of the aneurysmal sac is difficult because of its size and location.

keywords:

aneurysm, pancreatitis, thrombin

references:
Zabicki B, Limphaibool N, Holstad MJV, et al. Endovascular management of pancreatitis-related pseudoaneurysms: a review of techniques. PLoS One 2018; 13: e0191998.
Spezia L, Sozzi C, Contro A, et al. Successful post-pancreatitis pseudoaneurysm coagulation by percutaneous computed tomography (CT)-guided thrombin injection. Pol J Radiol 2017; 82: 24-27.
McErlean A, Looby S, Lee MJ. Percutaneous ultrasound-guided thrombin injection as first-line treatment of pancreatic pseudoaneurysm. Cardiovasc Intervent Radiol 2007; 30: 526-528.
Shrivastava A, Rampal JS, Reddy DN, et al. Direct needle puncture and embolization of splenic artery pseudoaneurysm in case of chronic atrophic calcific pancreatitis. Pol J Radiol 2016; 81: 462-464.
Saad NE, Saad WE, Davies MG, et al. Pseudoaneurysms and the role of minimally invasive techniques in their management. Radiographics 2005; 25 Suppl 1: S173-S189.
Kang SS, Labropoulos N, Mansour MA, et al. Expanded indications for ultrasound-guided thrombin injection of pseudoaneurysms. J Vasc Surg 2000; 31: 289-298.
 
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