Permissive untreated pseudoaneurysm concept in damage control interventional radiology for traumatic pancreaticoduodenal artery injury.
作者信息
Yonemitsu Takafumi, Shibata Naoaki, Shima Nozomu, Fuchigami Junya, Miyake Yuichi, Ikoma Akira, Minamiguchi Hiroki, Sonomura Tetsuo, Kato Seiya
机构信息
Department of Emergency and Critical Care Medicine Wakayama Medical University Wakayama City Japan.
Department of Radiology Wakayama Medical University Wakayama City Japan.
出版信息
Acute Med Surg. 2023 Feb 23;10(1):e823. doi: 10.1002/ams2.823. eCollection 2023 Jan-Dec.
BACKGROUND
Angioembolization for traumatic pancreaticoduodenal artery injury with unstable circulation, which characteristically requires a prolonged procedure time, does not yet have a standardized strategy for damage control interventional radiology.
CASE PRESENTATION
We encountered two cases of rare traumatic pancreaticoduodenal artery injury wherein the patients were saved by a multidisciplinary team with a shared goal of clinical success, rather than the procedural success of angioembolization. Both patients treated with angioembolization had residual pseudoaneurysm or faint extravasation in the pancreaticoduodenal artery arcade. We prioritized critical care with preemptive plasma transfusion and aggressive blood pressure control, and planned repeat angiography. The patients showed no clinical signs of rebleeding or pseudoaneurysm based on computed tomography during follow-up.
CONCLUSION
Our findings suggest that the permissive untreated pseudoaneurysm concept can be useful in developing damage control interventional radiology strategies for trauma cases with challenging time limitations, such as traumatic pancreaticoduodenal artery injury with circulatory collapse.
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