The experience in diagnosis and treatment of bleeding complications in severe acute pancreatitis (SAP) by transcatheter arterial embolization was summarized. The clinical data of 19 SAP patients complicated with intra-abdominal bleeding in our hospital from Jan. 2000 to Jan. 2003 were analyzed retrospectively and the therapeutic outcome of TAE was evaluated statistically. The results showed that the short-term successful rate of hemostasis by TAE was 89.5% (17/19), the incidence of re-bleeding after TAE was 36.8% (7/19) and the successful rate of hemostatis by second TAE was 71.4% (5/7). It was concluded that the intra-abdominal bleeding in SAP was mainly caused by the rupture of erosive/infected pseudoaneurysm. Mostly, the broken vessels were splenic artery and gastroduodenal artery; In terms of emergence hemostatis, TAE is the most effective method. Surgical hemostasis is necessary if hemostasis by TAE is failed or re-bleeding occurs after TAE.
Aneurysm, False/diagnosis ; Aneurysm, False/etiology ; Aneurysm, False/therapy ; *Embolization, Therapeutic/methods ; Hemoperitoneum/diagnosis ; Hemoperitoneum/etiology ; Hemoperitoneum/*therapy ; Pancreatic Pseudocyst/diagnosis ; Pancreatic Pseudocyst/etiology ; Pancreatic Pseudocyst/therapy ; Pancreatitis, Acute Necrotizing/*complications ; Pancreatitis, Acute Necrotizing/therapy ; Retrospective Studies

BACKGROUNDPseudoaneurysms (PAs) are common vascular abnormalities predominantly arising from a disruption in the integrity of the arterial wall. The potential complications of PAs are usually unpredictable and carry high rates of morbidity and mortality. This paper presents our experience with various treatment strategies for PAs.

METHODSFifty-four patients with 55 PAs were diagnosed by non-invasive imaging examination. The etiology of PAs included trauma (33/55), infection (5/55), iatrogenic (6/55), and idiopathic (11/55). Different procedures including ultrasound (US)-guided compression, endovascular treatment, and surgery were performed depending on the location of PAs, size of the sac and neck, and characteristics of the donor artery. The methods of endovascular treatment included embolization of parent artery, the PA sac, or implantation of a stent-graft. Follow-up was performed using US or CT and ranged from 1 day to 24 months (average 16.7 months).

RESULTSIn all 54 patients, 3 patients with superficial PAs were treated by US-guided compression, while 44 patients with 45 PAs located in the head and neck (n = 20), viscera (n = 10) or extremities (n = 15) were treated by endovascular treatment. Nine patients with PAs located in the head and neck (n = 2) or extremities (n = 7) were treated by surgery. Among them, one patient underwent endovascular treatment combined with surgery and 1 was treated by surgery after unsuccessful US-guided compression. In the 3 patients treated with US-guided compression, 2 were successfully treated while the remaining patient required additional surgery. Primary technical success of endovascular management was 97.7% (43/44) and the cure rate was 95.5% (42/44). In the surgery group, 4 patients recovered well, 1 patient was cured by endovascular treatment combined with surgery, 2 cases underwent amputation, 1 patient died of multi-organ failure and 1 patient was paralysed.

CONCLUSIONSMinimally invasive interventional techniques are established treatment methods for PA with favorable success rates and minimal morbidity. The therapeutic options should be tailored to the location, size and rupture risk of PA, condition of the donor artery and existing comorbidity.

Adult ; Aneurysm, False ; diagnosis ; etiology ; therapy ; Embolization, Therapeutic ; Female ; Humans ; Male ; Middle Aged

OBJECTIVETo report the experience in diagnosis and management of bleeding pseudoaneurysms associated with severe acute pancreatitis (SAP).

METHODSThe medical records of 12 patients with bleeding pseudoaneurysms associated with SAP treated between October 1990 and October 2006 were retrospectively reviewed. The etiologies of the 12 patients were gallstones in 6 patients, hyperlipidemia in 3 patients, hyperparathyroidism in 1 patient and the other 2 patients had no definitive causes.

RESULTSAbdominal computed tomography revealed bleeding pseudoaneurysms in 6 of 9 patients. Angiography determined correct diagnosis in 12 patients (12/12). The most involved vessels were peripancreatic arteries. Eight patients were managed by trans-catheter arterial embolization (TAE) as "one point" (a proximal point of the pseudo-aneurysm). Two patients were treated by TAE as "two points" (both distal and proximal to the pseudo-aneurysm). The last two cases were treated by surgery as suture and ligation. Four of the "one point" TAE patients were re-bleeding 4 to 7 days later, and 2 of them were treated with surgery, the other 2 patients were controlled with "two points" TAE. Three patients were died of infection and multiple organ dysfunction syndromes. Overall mortality rate was 25% (3/12).

CONCLUSIONSAngiography is the main diagnostic methods for bleeding pseudoaneurysms in SAP patients. "Two points" embolization and emergency surgery are an effective treatment options in these patients.

Adult ; Aged ; Aneurysm, False ; diagnosis ; etiology ; therapy ; Aneurysm, Ruptured ; diagnosis ; etiology ; therapy ; Angiography ; Embolization, Therapeutic ; Female ; Hemorrhage ; diagnosis ; etiology ; therapy ; Humans ; Ligation ; Male ; Middle Aged ; Pancreatitis, Acute Necrotizing ; complications ; Retrospective Studies ; Treatment Outcome

Aneurysm, False ; diagnosis ; diagnostic imaging ; etiology ; Cholecystitis ; diagnosis ; diagnostic imaging ; physiopathology ; Diabetes Mellitus ; diagnostic imaging ; therapy ; Humans ; Male ; Middle Aged ; Radiography

Here, we report a case of scalp pseudoaneurysm which was treated by direct puncture embolization using n-butyl-2-cyanoacrylate. The patient had a history of blunt trauma in the previous two months. Ultrasound-guided manual compression was initially attempted, but the results were unsatisfactory. Direct puncture embolization was then performed, and the pseudoaneurysm was completely obliterated. Non-surgical treatment options for pseudoaneurysm are briefly discussed.
Accidental Falls ; Aged ; Aged, 80 and over ; Aneurysm, False/diagnosis/etiology/*therapy ; Cyanoacrylates/*therapeutic use ; Embolization, Therapeutic/*methods ; Female ; Humans ; Punctures ; Scalp/*injuries ; Tomography, X-Ray Computed ; Ultrasonography, Doppler

Harms technique of C₁-C₂ fixation for atlantoaxial complex becomes more popular due to good fusion rate and low vertebral artery injury (VAI) rate. But considering the unique and variable anatomy of atlantoaxial complex, iatrogenic VAI will result in catastrophic consequences and provides particular surgical challenges for surgeons. To our knowledge, comparing with iatrogenic VAI in the screw hole, iatrogenic VAI in the "open space" is much rarer during the Harms technique of C₁-C₂ fixation. In this article, we present a case of iatrogenic vertebral artery pseudoaneurysm after Harms technique of posterior C₁-C₂ fixation. This case of iatrogenic VAI effectively treated by endovascular coil occlusion and external local compression was initially misdiagnosed as VAI by pedicle screw perforation. It can be concluded that intraoperative or postoperative computed angiography is very helpful to diagnose the exact site of VAI and the combination of endovascular coil occlusion as well as external local compression can further prevent bleeding and abnormal vertebral artery flow in the pseudoaneurysm. However, patients treated require further follow-up to confirm that there is no recurrence of the pseudoaneurysm.
Aneurysm, False ; diagnosis ; etiology ; therapy ; Cervical Vertebrae ; surgery ; Diagnostic Errors ; Humans ; Iatrogenic Disease ; Male ; Middle Aged ; Spinal Fusion ; adverse effects ; Vertebral Artery ; injuries

Dynamic hip screw fixation is a commonly performed procedure for internal fixation of intertrochanteric femoral fractures. Arterial injury following the operative fixation is a rare but serious event. We present a patient who developed pseudoaneurysm of profunda femoris artery after internal fixation of intertrochanteric fracture with a dynamic hip screw. The diagnosis was confirmed by angiographic study and it was successfully treated by coil embolization.
Accidental Falls ; Aged ; Aneurysm, False ; diagnostic imaging ; etiology ; therapy ; Angiography ; Bone Screws ; Embolization, Therapeutic ; Female ; Femoral Artery ; Femoral Fractures ; surgery ; Fracture Fixation, Internal ; methods ; Hip Fractures ; surgery ; Humans ; Postoperative Complications ; diagnosis ; etiology ; therapy

A 23-year-old man presented with abdominal pain after suffering blunt trauma caused by a seatbelt injury. His low platelet count of 137 × 10(9)/L was initially attributed to trauma and his underlying hypersplenism due to glucose-6-phosphate dehydrogenase (G6PD) deficiency. Despite conservative management, his platelet count remained persistently reduced even after his haemoglobin and clotting abnormalities were stabilised. After a week, follow-up imaging revealed an incidental finding of a pseudoaneurysm (measuring 9 mm × 8 mm × 10 mm) adjacent to a splenic laceration. The pseudoaneurysm was successfully closed via transcatheter glue embolisation; 20% of the spleen was also embolised. A week later, the platelet count normalised, and the patient was subsequently discharged. This case highlights the pitfalls in the detection of a delayed occurrence of splenic artery pseudoaneurysm after blunt injury via routine delayed phase computed tomography. While splenomegaly in G6PD may be a predisposing factor for injury, a low platelet count should arouse suspicion of internal haemorrhage rather than hypersplenism.
Abdominal Pain ; diagnosis ; etiology ; Accidents, Traffic ; Aneurysm, False ; diagnostic imaging ; etiology ; therapy ; Embolization, Therapeutic ; methods ; Follow-Up Studies ; Glucosephosphate Dehydrogenase Deficiency ; complications ; diagnosis ; Humans ; Injury Severity Score ; Male ; Rare Diseases ; Risk Assessment ; Seat Belts ; adverse effects ; Splenic Artery ; injuries ; Tomography, X-Ray Computed ; methods ; Treatment Outcome ; Wounds, Nonpenetrating ; complications ; diagnosis ; Young Adult