Major vascular complications related to pancreatitis can cause life-threatening hemorrhage and have to be dealt with as an emergency, utilizing a multidisciplinary approach of angiography, endoscopy or surgery. These may occur secondary to direct vascular injuries, which result in the formation of splanchnic pseudoaneurysms, gastrointestinal etiologies such as peptic ulcer disease and gastroesophageal varices, and post-operative bleeding related to pancreatic surgery. In this review article, we discuss the pathophysiologic mechanisms, diagnostic modalities, and treatment of pancreatic vascular complications, with a focus on the role of minimally-invasive interventional therapies such as angioembolization, endovascular stenting, and ultrasound-guided percutaneous thrombin injection in their management.
Diagnostic Imaging ; Embolization, Therapeutic/methods ; Hemostasis, Endoscopic ; Hemostatics/administration & dosage ; Humans ; Pancreatitis/*complications ; Stents ; Thrombin/administration & dosage ; Ultrasonography, Interventional ; Vascular Diseases/diagnosis/*etiology/physiopathology/*therapy ; Vascular Surgical Procedures/*methods

BACKGROUND/AIMS: Osteoprotegerin (OPG) and fetuin-A are vascular calcification regulators that may be related to high cardiovascular (CV) mortality in hemodialysis (HD) patients. We evaluated the relationship between OPG, fetuin-A, and pulse wave velocity (PWV), a marker of vascular stiffness, and determined whether OPG and fetuin-A were independent predictors of CV events in HD patients. METHODS: We conducted a prospective observational study in 97 HD patients. OPG and fetuin-A were measured at baseline and arterial stiffness was evaluated by PWV. All patients were stratified into tertiles according to serum OPG levels. RESULTS: A significant trend was observed across increasing serum OPG concentration tertiles for age, HD duration, systolic blood pressure, cholesterol, triglycerides, and PWV. Multiple linear regression analysis revealed that diabetes (beta = 0.430, p = 0.000) and OPG levels (beta = 0.308, p = 0.003) were independently associated with PWV. The frequency of new CV events was significantly higher in the upper OPG tertiles compared with those in the lower OPG tertiles. In Cox proportional hazards analysis, upper tertiles of OPG levels were significantly associated with CV events (hazard ratio = 4.536, p = 0.011). CONCLUSIONS: Serum OPG, but not fetuin-A, levels were closely associated with increased vascular stiffness, and higher OPG levels may be independent predictors of new CV events in HD patients.
Adult ; Aged ; Biological Markers/blood ; Cardiovascular Diseases/blood/diagnosis/*etiology/mortality/physiopathology ; Female ; Humans ; Kaplan-Meier Estimate ; Linear Models ; Male ; Middle Aged ; Multivariate Analysis ; Osteoprotegerin/*blood ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Pulse Wave Analysis ; *Renal Dialysis/adverse effects/mortality ; Renal Insufficiency, Chronic/complications/diagnosis/mortality/*therapy ; Risk Factors ; Up-Regulation ; *Vascular Stiffness ; alpha-2-HS-Glycoprotein/analysis