Gabrielli Daniela, Taglialatela Francesco, Mantini Cesare, Giammarino Alberto, Modestino Francesco, Cotroneo Antonio Raffaele
Department of Neuroscience and Imaging, Institute of Radiology, Section of Diagnostic Imaging and Therapy-Radiology Division, "G. d'Annunzio" University, Chieti-Pescara, Italy.
Department of Neuroscience and Imaging, Institute of Radiology, Section of Diagnostic Imaging and Therapy-Radiology Division, "G. d'Annunzio" University, Chieti-Pescara, Italy.
Ann Vasc Surg. 2017 Nov;45:112-116. doi: 10.1016/j.avsg.2017.05.035. Epub 2017 Jun 7.
To analyze our experience in endovascular treatment as first-line approach for severe and acute hemorrhage in patients with chronic pancreatitis.
From 2010 to 2016 at our institution, 12 males (mean age 66 years) with bleeding pseudoaneurysms (PSAs) underwent urgent visceral angiography and endovascular treatment. All patients had chronic pancreatitis. True visceral artery aneurysms and PSAs arising after surgery were excluded from the study.
Pancreatitis was caused by alcohol abuse in 9 (9/12, 75%) patients and biliary lithiasis in 3 (3/12, 25%). Involved arteries were gastroduodenal (5/12, 50%), splenic (2/12, 16%), common hepatic (2/12, 16%), middle colic (1/12, 9%), and celiac trunk (1/12, 9%). All patients underwent computed tomography angiography (CTA) scan and visceral angiography followed by endovascular treatment using different devices. Technical success rate was 100%. Bleeding was stopped in all patients, and no one required reembolization. No major complications occurred. There were 2 complications associated with the endovascular procedure: in one case, a coil migration and in another case, in-stent restenosis at 6 months. Follow-up included CTA performed during hospitalization and at 6 months after the procedure.
Our experience confirms the role of CTA and visceral angiography as diagnostic and therapeutic tool, respectively.
分析我们将血管内治疗作为慢性胰腺炎患者严重急性出血一线治疗方法的经验。
2010年至2016年在我们机构，12名男性（平均年龄66岁）患有出血性假性动脉瘤（PSA），接受了紧急内脏血管造影和血管内治疗。所有患者均患有慢性胰腺炎。真性内脏动脉瘤和手术后出现的PSA被排除在研究之外。
9例（9/12，75%）患者的胰腺炎由酒精滥用引起，3例（3/12，25%）由胆石症引起。受累动脉为胃十二指肠动脉（5/12，50%）、脾动脉（2/12，16%）、肝总动脉（2/12，16%）、中结肠动脉（1/12，9%）和腹腔干（1/12，9%）。所有患者均接受了计算机断层扫描血管造影（CTA）和内脏血管造影，随后使用不同装置进行血管内治疗。技术成功率为100%。所有患者出血均停止，无人需要再次栓塞。未发生重大并发症。血管内手术有2例并发症：1例弹簧圈移位，另1例在6个月时出现支架内再狭窄。随访包括住院期间和术后6个月进行的CTA检查。
我们的经验证实了CTA和内脏血管造影分别作为诊断和治疗工具的作用。
