De Rosa Antonella, Gomez Dhanwant, Pollock John G, Bungay Peter, De Nunzio Mario, Hall Richard I, Thurley Peter
Department of Hepatobiliary Surgery and Pancreatic Surgery, Royal Derby Hospital, Derby Hospitals NHS Foundation Trust, Derby, UK.
JOP. 2012 Nov 10;13(6):660-6. doi: 10.6092/1590-8577/1193.
Pseudoaneurysms associated with pancreatitis are rare, and bleeding pseudoaneurysms are associated with a high mortality.
The aim of this study was to report the outcomes of endovascular and percutaneous therapy in the management of pseudoaneurysms secondary to pancreatitis.
Patients who underwent angiography for pseudoaneurysms associated with pancreatitis from 2005 to 2011 were identified from the angiography database.
Patient demographics, clinical presentation, radiological findings, treatment, and outcomes were retrospectively reviewed.
Nineteen pseudoaneurysms associated with pancreatitis in 13 patients were identified. The diagnosis of a pseudoaneurysm was made by computerised tomography angiography in seven patients, followed by portal venous phase contrast enhanced CT (n=4), duplex ultrasound (n=1) and angiography (n=1). At angiography, coil embolisation was attempted in 11 patients with an initial success rate of 82% (n=9). One patient underwent successful embolisation with percutaneous thrombin injection. The recurrence rate following initial successful embolisation was 11% (n=1). There were no episodes of re-bleeding following embolisation but re-bleeding following thrombin injection was observed in one case. The morbidity and mortality rate in the 12 patients that were successfully treated was 25% (n=3) and 8% (n=1), respectively. All 12 patients that were successfully treated demonstrated radiological resolution of their pseudoaneurysms, with a median follow-up of 20 months.
Endovascular embolisation is a suitable first-line management strategy associated with low recurrence rates. The role of percutaneous thrombin injection is yet to be defined.
与胰腺炎相关的假性动脉瘤罕见，而出血性假性动脉瘤死亡率高。
本研究旨在报告血管内及经皮治疗胰腺炎继发性假性动脉瘤的结果。
从血管造影数据库中识别出2005年至2011年因与胰腺炎相关的假性动脉瘤接受血管造影的患者。
对患者的人口统计学、临床表现、影像学检查结果、治疗及结局进行回顾性分析。
共识别出13例患者的19个与胰腺炎相关的假性动脉瘤。7例患者通过计算机断层血管造影诊断为假性动脉瘤，随后分别有4例通过门静脉期对比增强CT、1例通过双功超声、1例通过血管造影确诊。血管造影时，11例患者尝试进行弹簧圈栓塞，初始成功率为82%（9例）。1例患者通过经皮注射凝血酶成功栓塞。初始成功栓塞后的复发率为11%（1例）。栓塞后无再出血事件，但1例患者经凝血酶注射后出现再出血。12例成功治疗的患者中，发病率和死亡率分别为25%（3例）和8%（1例）。所有12例成功治疗的患者假性动脉瘤均获得影像学消退，中位随访时间为20个月。
血管内栓塞是一种合适的一线治疗策略，复发率低。经皮注射凝血酶的作用尚待确定。
