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Vascular Complications of Pancreatitis: Imaging and Intervention

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Abstract

The objective of this study was to highlight technical challenges and potential pitfalls of diagnostic imaging, intervention, and postintervention follow-up of vascular complications of pancreatitis. Diagnostic and interventional radiology imaging from patients with pancreatitis from 2002 to 2006 was reviewed. We conclude that biphasic CT is the diagnostic modality of choice. Catheter angiography may (still) be required to diagnose small pseudoaneurysms. Endovascular coiling is the treatment of choice for pseudoaneurysms. Close clinical follow-up is required, as patients may rebleed/develop aneurysms elsewhere.

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References

  1. Balthazar EJ, Fisher LA (2001) Hemorrhagic complications of pancreatitis: radiologic evaluation with emphasis on CT imaging. Pancreatology 1(4):306–313

    Article  PubMed  CAS  Google Scholar 

  2. Mortele KJ, Mergo PJ, Taylor HM, Wiesner W, Cantisani V, Ernst MD, Kalantari BN, Ros PR (2004) Peripancreatic vascular abnormalities complicating acute pancreatitis: contrast-enhanced helical CT findings. Eur J Radiol 52(1):67–72

    Article  PubMed  Google Scholar 

  3. Bergert H, Dobrowolski F, Caffier S, Bloomenthal A, Hinterseher I, Saeger HD (2004) Prevalence and treatment of bleeding complications in chronic pancreatitis. Langenbecks Arch Surg 389(6):504–510 [Epub 2 June 2004]

    Article  PubMed  CAS  Google Scholar 

  4. Cuthbertson CM, Christophi C (2006) Disturbances of the microcirculation in acute pancreatitis. Br J Surg 93(5):518–530

    Article  PubMed  CAS  Google Scholar 

  5. Takeda K, Mikami Y, Fukuyama S, Egawa S, Sunamura M, Ishibashi T, Sato A, Masamune A, Matsuno S (2005) Pancreatic ischemia associated with vasospasm in the early phase of human acute necrotizing pancreatitis. Pancreas 30(1):40–49

    PubMed  Google Scholar 

  6. Mallick IH, Winslet MC (2004) Vascular complications of pancreatitis. JOP 5(5):328–337

    PubMed  Google Scholar 

  7. Boudghene F, L’Hermine C, Bigot JM (1993) Arterial complications of pancreatitis: diagnostic and therapeutic aspects in 104 cases. J Vasc Interv Radiol 4(4):551–558

    Article  PubMed  CAS  Google Scholar 

  8. Vujic I (1989) Vascular complications of pancreatitis. Radiol Clin North Am 27(1):81–91

    PubMed  CAS  Google Scholar 

  9. Rickes S, Uhle C, Kahl S, Kolfenbach S, Monkemuller K, Effenberger O, Malfertheiner P (2006) Echo enhanced ultrasound: a new valid initial imaging approach for severe acute pancreatitis. Gut 55(1):74–78 [Epub 20 July 2005]

    Article  PubMed  CAS  Google Scholar 

  10. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH (1990) Acute pancreatitis: value of CT in establishing prognosis. Radiology 174(2):331–336

    PubMed  CAS  Google Scholar 

  11. Gurleyik G, Emir S, Kilicoglu G, Arman A, Saglam A (2005) Computed tomography severity index, APACHE II score, and serum CRP concentration for predicting the severity of acute pancreatitis. JOP 6(6):562–567

    PubMed  Google Scholar 

  12. Leung TK, Lee CM, Lin SY, Chen HC, Wang HJ, Shen LK, Chen YY (2005) Balthazar computed tomography severity index is superior to Ranson criteria and APACHE II scoring system in predicting acute pancreatitis outcome. World J Gastroenterol 11(38):6049–6052

    PubMed  Google Scholar 

  13. Hyare H, Desigan S, Nicholl H, Guiney MJ, Brookes JA, Lees WR (2006) Multi-section CT angiography compared with digital subtraction angiography in diagnosing major arterial hemorrhage in inflammatory pancreatic disease. Eur J Radiol 59(2):295–300 [Epub 20 March 2006]

    PubMed  Google Scholar 

  14. Nicholson AA, Patel J, McPherson S, Shaw DR, Kessel D (2006) Endovascular treatment of visceral aneurysms associated with pancreatitis and a suggested classification with therapeutic implications. J Vasc Interv Radiol 17(8):1279–1285

    Article  PubMed  Google Scholar 

  15. Deshmukh H, Rathod K, Garg A, Sheth R, Kulkarni S (2004) Transcatheter embolization as primary treatment for visceral pseudoaneurysms in pancreatitis: clinical outcome and imaging follow up. Indian J Gastroenterol 23(2):56–58

    PubMed  Google Scholar 

  16. Mendelson RM, Anderson J, Marshall M, Ramsay D (2005) Vascular complications of pancreatitis. Aust NZ J Surg 75(12):1073–1079

    Article  Google Scholar 

  17. Mauro MA, Jaques P (1991) Transcatheter management of pseudoaneurysms complicating pancreatitis. J Vasc Interv Radiol 2(4):527–532

    PubMed  CAS  Google Scholar 

  18. Golzarian J, Nicaise N, Deviere J, Ghysels M, Wery D, Dussaussois L, Van Gansbeke D, Struyven J (1997) Transcatheter embolization of pseudoaneurysms complicating pancreatitis. Cardiovasc Interv Radiol 20(6):435–440

    Article  CAS  Google Scholar 

  19. Dasgupta et al. (2002) Haemosuccus pancreaticus: treatment by arterial embolization. Clin Radiol 57(11):1021–1027

  20. Savastano S, Feltrin GP, Antonio T, Miotto D, Chiesura-Corona M, Castellan L (1993) Arterial complications of pancreatitis: diagnostic and therapeutic role of radiology. Pancreas 8(6):687–692

    Article  PubMed  CAS  Google Scholar 

  21. Gambiez LP, Ernst OJ, Merlier OA, Porte HL, Chambon JP, Quandalle PA (1997) Arterial embolization for bleeding pseudocysts complicating chronic pancreatitis Arch Surg 132(9):1016–1021

    PubMed  CAS  Google Scholar 

  22. de Perrot M, Berney T, Buhler L, Delgadillo X, Mentha G, Morel P (1999) Management of bleeding pseudoaneurysms in patients with pancreatitis. Br J Surg 86(1):29–32

    Article  PubMed  Google Scholar 

  23. Carr JA, Cho JS, Shepard AD, Nypaver TJ, Reddy DJ (2000) Visceral pseudoaneurysms due to pancreatic pseudocysts: rare but lethal complications of pancreatitis. J Vasc Surg 32(4):722–730

    Article  PubMed  CAS  Google Scholar 

  24. Beattie GC, Hardman JG, Redhead D, Siriwardena AK (2003) Evidence for a central role for selective mesenteric angiography in the management of the major vascular complications of pancreatitis. Am J Surg 185(2):96–102

    Article  PubMed  Google Scholar 

  25. Hyare H, Desigan S, Brookes JA, Guiney MJ, Lees WR (2007) Endovascular management of major arterial hemorrhage as a complication of inflammatory pancreatic disease. J Vasc Interv Radiol 18(5):591–596

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. McMaster University Medical Center, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada

    John M. Kirby, Parag Vora, Mehran Midia & John Rawlinson

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  1. John M. Kirby
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  2. Parag Vora
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  3. Mehran Midia
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  4. John Rawlinson
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Correspondence to John M. Kirby.

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Kirby, J.M., Vora, P., Midia, M. et al. Vascular Complications of Pancreatitis: Imaging and Intervention. Cardiovasc Intervent Radiol 31, 957–970 (2008). https://doi.org/10.1007/s00270-007-9138-y

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  • DOI: https://doi.org/10.1007/s00270-007-9138-y

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