Transcatheter microcoil embolotherapy for ruptured pseudoaneurysm following pancreatic and biliary surgery.

PURPOSE

To evaluate the outcome of transcatheter microcoil embolotherapy for bleeding pseudoaneurysms complicating major pancreatic and biliary surgery.

MATERIALS AND METHODS

Over an 8-year period, 8 patients were encountered who developed massive bleeding from pseudoaneurysms 15-64 days (mean 31 days) following major pancreatic and biliary surgery. Urgent transcatheter microcoil embolotherapy was performed in all 8 patients.

RESULTS

Transcatheter embolotherapy was successful in 7 of 8 patients (88%) but failed in one due to development of disseminated intravascular coagulation. One patient developed recurrent bleeding 36 days after the first embolotherapy from a newly developed pseudoaneurysm, which was again treated successfully with embolization. Two patients subsequently underwent additional surgery for residual pathology. Three of the 7 patients with successful embolotherapy were alive at 10-96 months, 4 patients died of associated malignancies 4-20 months after embolotherapy.

CONCLUSION

Transcatheter microcoil embolotherapy is effective for bleeding pseudoaneurysms complicating pancreatic and biliary surgery, and should be considered the first treatment of choice.