Endovascular micro-arterial stenting for arterial pseudoaneurysm after pancreatic surgery
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Endovascular micro‑arterial stenting for arterial pseudoaneurysm after pancreatic surgery Yoshihiro Shirai1,2 · Kenei Furukawa1 · Hirokazu Ashida3 · Takeshi Gocho1 · Shinji Onda1 · Ryoga Hamura1,2 · Shunsuke Nakashima1 · Hiroya Ojiri3 · Toru Ikegami1 Received: 14 July 2020 / Accepted: 8 September 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Although arterial pseudoaneurysm is one of the most serious complications after pancreatic surgery, the best practice with maximum efficacy and minimum adverse effects to overcome such a serious situation has not yet been elucidated. We performed endovascular micro-arterial stenting (EMAS) to manage this serious situation while preserving a sufficient hepatic arterial flow, and herein report the technical details and challenges of the procedure. Dilation of the stent using a balloon catheter to adhere to the parent artery, and embolization of the surrounding artery to prevent type I and type II endo-leaks are the most important points for ensuring a successful procedure. We applied this technique to 6 cases of hepatic arterial pseudoaneurysm, with a mean size of 6.5 ± 1.3 mm. The mean time of the procedure was 81 ± 22 min, without adverse events, including hepatic necrosis or arterial bleeding. EMAS may be the ideal procedure for treating pseudoaneurysm after pancreatic surgery while preserving the hepatic arterial inflow. Keywords Pseudoaneurysm · Stent · Hepatic artery Abbreviations EMAS Endovascular micro-arterial stenting CHA Common hepatic artery PHA Proper hepatic artery GDA Gastroduodenal artery CT Computed tomography LHA Left hepatic artery
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00595-020-02149-6) contains supplementary material, which is available to authorized users. * Yoshihiro Shirai [email protected] 1
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3‑25‑8, Nishi‑Shinbashi, Minato‑ku, Tokyo 105‑8461, Japan
2
Division of Gene Therapy, Research Center for Medical Science, The Jikei University School of Medicine, 3‑25‑8, Nishi‑Shinbashi, Minato‑ku, Tokyo 105‑8461, Japan
3
Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
Introduction Ruptured arterial pseudoaneurysm is one of the most serious and life-threatening complications after pancreatic surgery, including pancreaticoduodenectomy and distal pancreatectomy. The most common cause of arterial pseudoaneurysm is the erosion of the arterial wall by amylase-rich pancreas juice due to a pancreatic fistula [1, 2]. The incidence of catastrophic hemorrhaging from a ruptured pseudoaneurysm in such situations has been reported to be between 2 and 11% [3–5], and the mortality rate for massive arterial hemorrhaging was shown to be almost 50% [6]. It has been recognized that surgical hemostasis for ruptured pseudoaneurysm is not appropriate, as difficulties locating the bleeding point in an eroded surgical field in such cases
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