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Successful treatment of pseudoaneurysms of celiac and superior mesenteric arteries by combined endovascular and surgical approach
Author(s) -
Saito Takuro,
Tsuchiya Takao,
Kenjo Akira,
Kimura Takashi,
Sato Yoshihiro,
Saito Takaharu,
Anazawa Takayuki,
Takase Shinya,
Satokawa Hirono,
Satoh Youichi,
Yokoyama Hitoshi,
Ohira Hiromasa,
Rai Tsuyoshi,
Gotoh Mitsukazu
Publication year - 2008
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s00534-007-1238-1
Subject(s) - medicine , pseudoaneurysm , superior mesenteric artery , celiac artery , surgery , radiology , mesenteric arteries , abdominal aorta , aorta , stent , angiography , stenosis , artery , aneurysm
Pseudoaneurysm after pancreas resection poses serious complications, including rupture and hemorrhage. Here we report a case of delayed massive hemorrhage from celiac and superior mesenteric arteries, which was successfully treated with a combined endovascular and surgical approach. The patient was a 52‐year‐old man who presented with pseudoaneurysms of the celiac and superior mesenteric arteries after distal pancreatectomy. Following the detection of sentinel bleeding from the abdominal drain, emergency angiography of the celiac and superior mesenteric arteries revealed stenosis of the celiac artery and pseudoaneurysms in the superior mesenteric artery. We occluded these lesions with a platinum coil, using an interventional radiological technique combined with bypass grafting between the abdominal aorta and the SMA, using the saphenous vein. However, re‐bleeding into the abdominal cavity occurred from the proximal SMA pseudoaneurysm. We inserted an endoluminal stent‐graft into the abdominal aorta and completed bypass grafting between the aorta and bilateral renal arteries. The hemorrhage ceased and the postoperative course was uneventful. The patient was discharged 34 days after the treatment (149 days after the initial operation). In conclusion, this combined endovascular and surgical approach is feasible and seems appropriate for pseudoaneurysms arising from proximal sites in visceral arteries.