Journal List > J Korean Soc Radiol > v.66(3) > 1087087

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Kang, Kim, Kim, Ahn, and Lee: Miscellaneous Endovascular Treatment of Ruptured Hepatic Artery Pseudoaneurysms after Pylorus Preserving Pancreaticoduodenectomy
Original Article
Interventional Radiology
Journal of the Korean Society of Radiology

Journal of the Korean Society of Radiology 2012; 66(3): 247-254.

Published online: 21 March 2012

DOI: https://doi.org/10.0000/jksr.2012.66.3.247

Miscellaneous Endovascular Treatment of Ruptured Hepatic Artery Pseudoaneurysms after Pylorus Preserving Pancreaticoduodenectomy

Ung Rae Kang, MD1, Young Hwan Kim, MD2, See Hyung Kim, MD2, Eun Joung Ahn, MD2, Young Hwan Lee, MD1

1Department of Radiology, Catholic University of Daegu School of Medicine, Daegu Catholic University Medical Center, Daegu, Korea.

2Department of Radiology, Keimyung University College of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea.

Corresponding author: Young Hwan Kim, MD. Department of Radiology, Keimyung University College of Medicine, Keimyung University Dongsan Medical Center, 56 Dalseong-ro, Jung-gu, Daegu 700-712, Korea. Tel. 82-53-250-7767, Fax. 82-53-250-7767, yhkim68@dsmc.or.kr

Received 2 December 2011       Accepted 17 January 2012

Copyright © 2012 The Korean Society of Radiology

Abstract

Purpose

To assess the feasibility and safety of the endovascular treatment of ruptured hepatic artery pseudoaneurysms after pylorus preserving pancreaticoduodenectomy (PPPD).

Materials and Methods

Thirteen patients with hepatic artery pseudoaneurysm after PPPD were enrolled. Various endovascular techniques were used depending on the sites and morphologies of the pseudoaneurysms. Five cases were treated by coil embolization, five with stent-graft, one by thrombin injection and coil embolization, one with stent-graft and coil embolization, and one with N-butyl cyanoacrylate (NBCA) injection. Computed tomography scans and liver function test were performed after the procedures.

Results

Pseudoaneurysm exclusion and bleeding cessation was achieved in all patients. In four patients that underwent coil or NBCA embolization of the hepatic artery, aspartate transaminase (AST) and alanine transaminase (ALT) were markedly elevated. Two of these four patients with narrowing of the portal vein due to surrounding hematoma died of hepatic infarction or hepatic abscess. In other nine patients, AST and ALT were unchanged. In the 11 surviving patients, normal hepatic function and complete pseudoaneurysm disappearance were achieved during follow-up.

Conclusion

Endovascular treatment of ruptured hepatic artery pseudoaneurysms can be considered as a feasible and safe method. However, complete occlusion of the hepatic artery with coils should be avoided in patients with inadequate portal flow.

Keywords: Pseudoaneurysm, Pylorus Preserving Pancreaticoduodenectomy, Hepatic Artery, Endovascular Treatment

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