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Title: Pseudoaneurysms of the Common Hepatic Artery Following Pancreaticoduodenectomy: Successful Emergency Embolization

Abstract

We report a rare case of two communicating pseudoaneurysms of the common hepatic artery 1 month postoperatively following pylorus-preserving pancreaticoduodenectomy due an abscess formation. We describe the superselective transcatheteral embolization technique with deployment of interlocking detachable coils and Histoacryl-Lipiodol in this case and discuss the recent literature. Despite the technical success by achieving hemodynamic stability with initial preservation of liver function, the patient died 23 days postembolization due to multiorgan failure.

Authors:
; ; ;  [1];  [2]; ;  [1]
  1. University Hospital Heidelberg, Department of Diagnostic Radiology (Germany)
  2. University Hospital Heidelberg, Department of Surgery (Germany)
Publication Date:
OSTI Identifier:
21091065
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 30; Journal Issue: 1; Other Information: DOI: 10.1007/s00270-005-0372-x; Copyright (c) 2007 Springer Science+Business Media, Inc.; www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ABSCESSES; ACCIDENTS; ARTERIES; FAILURES; LIPIODOL; LIVER

Citation Formats

Radeleff, Boris, E-mail: Boris_radeleff@med.uni-heidelberg.de, Noeldge, Gerd, Heye, Tobias, Schlieter, Martin, Friess, Helmut, Richter, Goetz M., and Kauffmann, Guenter W. Pseudoaneurysms of the Common Hepatic Artery Following Pancreaticoduodenectomy: Successful Emergency Embolization. United States: N. p., 2007. Web. doi:10.1007/S00270-005-0372-X.
Radeleff, Boris, E-mail: Boris_radeleff@med.uni-heidelberg.de, Noeldge, Gerd, Heye, Tobias, Schlieter, Martin, Friess, Helmut, Richter, Goetz M., & Kauffmann, Guenter W. Pseudoaneurysms of the Common Hepatic Artery Following Pancreaticoduodenectomy: Successful Emergency Embolization. United States. doi:10.1007/S00270-005-0372-X.
Radeleff, Boris, E-mail: Boris_radeleff@med.uni-heidelberg.de, Noeldge, Gerd, Heye, Tobias, Schlieter, Martin, Friess, Helmut, Richter, Goetz M., and Kauffmann, Guenter W. Thu . "Pseudoaneurysms of the Common Hepatic Artery Following Pancreaticoduodenectomy: Successful Emergency Embolization". United States. doi:10.1007/S00270-005-0372-X.
@article{osti_21091065,
title = {Pseudoaneurysms of the Common Hepatic Artery Following Pancreaticoduodenectomy: Successful Emergency Embolization},
author = {Radeleff, Boris, E-mail: Boris_radeleff@med.uni-heidelberg.de and Noeldge, Gerd and Heye, Tobias and Schlieter, Martin and Friess, Helmut and Richter, Goetz M. and Kauffmann, Guenter W.},
abstractNote = {We report a rare case of two communicating pseudoaneurysms of the common hepatic artery 1 month postoperatively following pylorus-preserving pancreaticoduodenectomy due an abscess formation. We describe the superselective transcatheteral embolization technique with deployment of interlocking detachable coils and Histoacryl-Lipiodol in this case and discuss the recent literature. Despite the technical success by achieving hemodynamic stability with initial preservation of liver function, the patient died 23 days postembolization due to multiorgan failure.},
doi = {10.1007/S00270-005-0372-X},
journal = {Cardiovascular and Interventional Radiology},
number = 1,
volume = 30,
place = {United States},
year = {Thu Feb 15 00:00:00 EST 2007},
month = {Thu Feb 15 00:00:00 EST 2007}
}
  • PurposeTo describe the incidence of multiple renal artery pseudoaneurysms (PSA) in patients referred for renal artery embolization following partial nephrectomy and to study its relationship to RENAL nephrometry scores.Materials and MethodsThe medical records of 25 patients referred for renal artery embolization after partial nephrectomy were retrospectively reviewed for the following parameters: size and number of tumors, RENAL nephrometry scores, angiographic abnormalities, technical and clinical outcomes, and estimated glomerular filtration rates (eGFRs) after embolization.ResultsTwenty-four patients had primary renal tumors, while 1 patient had a pancreatic tumor invading the kidney. Multiple tumors were resected in 4 patients. Most patients (92 %) were symptomatic,more » presenting with gross hematuria, flank pain, or both. Angiography revealed PSA with (n = 5) or without (n = 20) AV fistulae. Sixteen patients (64 %) had multiple PSA involving multiple renal vessels. Higher RENAL nephrometry scores were associated with an increasing likelihood of multiple PSA. Multiple vessels were embolized in 14 patients (56 %). Clinical success was achieved after one (n = 22) or two (n = 3) embolization sessions in all patients. Post-embolization eGFR values at different time points after embolization were not significantly different from the post-operative eGFR.ConclusionA majority of patients requiring renal artery embolization following partial nephrectomy have multiple pseudoaneurysms, often requiring selective embolization of multiple vessels. Higher RENAL nephrometry score is associated with an increasing likelihood of multiple pseudoaneurysms. We found transarterial embolization to be a safe and effective treatment option with no long-term adverse effect on renal function in all but one patient with a solitary kidney.« less
  • Aneurysm of the common carotid artery is a rare and serious disease requiring prompt treatment in order to avoid neurologic complications. A 39-year-old man presented with voice impairment and a pulsatile mass at the right side of his neck and was found by color Doppler examination to have bilateral common carotid artery aneurysms of unknown origin. The right-sided large aneurysm was treated with placement of an 8 mm interposition Gore-Tex graft between the right common and internal carotid arteries. The surgical graft thrombosed 7 days after the surgery but the left-sided aneurysm was successfully treated by a Jostent peripheral stent-graft.more » Color Doppler examination showed a patent stent and no filling of the aneurysm on his first and sixth-month follow-up. Bilateral common carotid artery aneurysm is an exceptionally unusual condition and endovascular treatment of carotid artery aneurysms with covered stents may become an effective treatment alternative for these lesions.« less
  • Hepatic encephalopathy is considered a contraindication to hepatic artery embolization. We describe a patient with a well-differentiated neuroendocrine tumor metastatic to the liver with refractory hepatic encephalopathy and normal liver function tests. The encephalopathy was refractory to standard medical therapy with lactulose. The patient's mental status returned to baseline after three hepatic artery embolization procedures. Arteriography and ultrasound imaging before and after embolization suggest that the encephalopathy was due to arterioportal shunting causing hepatofugal portal venous flow and portosystemic shunting. In patients with a primary or metastatic well-differentiated neuroendocrine tumor whose refractory hepatic encephalopathy is due to portosystemic shunting (rathermore » than global hepatic dysfunction secondary to tumor burden), hepatic artery embolization can be performed safely and effectively.« less
  • A 40-year-old man, a chronic alcoholic, presented with acute epigastric pain. Selective celiac arteriography showed a pseudoaneurysm arising from the common hepatic artery. We hereby describe a technical innovation where complete pseudoaneurysm exclusion was seen after intra-aneurysmal N-butyl 2-cyanoacrylate (glue) injection with preservation of antegrade hepatic arterial flow and conclude that intra-aneurysmal liquid injection may have potential as a therapeutic option to reconstruct a defective vessel wall and thereby maintain the antegrade flow.
  • No abstract prepared.