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LETTER
Year : 2012  |  Volume : 58  |  Issue : 4  |  Page : 328

Endovascular management in aortic pseudoaneurysms caused by acute pancreatitis


Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore

Date of Web Publication4-Jan-2013

Correspondence Address:
S Srinivasan
Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central
Singapore
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0022-3859.105474

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How to cite this article:
Srinivasan S, Babu S B. Endovascular management in aortic pseudoaneurysms caused by acute pancreatitis. J Postgrad Med 2012;58:328

How to cite this URL:
Srinivasan S, Babu S B. Endovascular management in aortic pseudoaneurysms caused by acute pancreatitis. J Postgrad Med [serial online] 2012 [cited 2020 Apr 3];58:328. Available from: http://www.jpgmonline.com/text.asp?2012/58/4/328/105474


Sir,

We read with great interest, the report of a rare case describing an aortic pseudoaneurysm, secondary to pancreatitis. [1] It is interesting to note that aorta is resistant to formation of pseudoaneurysm unlike the smaller arteries like splenic artery or gastro-duodenal artery. [2] Management of pseudoaneurysms of these smaller arteries is easy and endovascular stent-graft placement or coil embolization is the preferred treatment. Surgical management has been the choice for pancreatitis-induced aortic aneurysm repair as mentioned by the author and traditionally followed for such cases. However, there are recent reports [2],[3] which describe cases managed successfully by endovascular aortic repair. Endovascular stent-graft placement is technically less challenging, safer and can be done with local anesthesia. Moreover technology has significantly improved in the past decade with significant advances in the prosthetic stents and stent grafts. There is a controversy that pancreatic pseudoaneurysms may be infected and theoretically stent grafts are contraindicated in infected aneurysms or pseudoaneurysms. [2] However, the priority is given to saving life of the patient and pancreatic surgery may be done electively, at a later date. Late complications like re-perforation following initial endovascular repair may occur, as in the case described recently by Stefanczyk et al., [4] which was again successfully managed by a bifurcated stent graft. Hence, we feel that endovascular repair has to be the first line of management in such patients to reduce the morbidity and mortality.

 
 :: References Top

1.Subhash R, Iyoob VA, Bonny N. Complicated acute pancreatitis: The worst-case scenario. J Postgrad Med 2012;58:154-5.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Hinchliffe RJ, Yung M, Hopkinson BR. Endovascular exclusion of a ruptured pseudoaneurysm of the infrarenal abdominal aorta secondary to pancreatitis. J Endovasc Ther 2002;9:590-2.  Back to cited text no. 2
[PUBMED]    
3.Hower J, Burton E, Agrawal ST 4 th , Simone S, Stahlfeld K. Abdominal aortic pseudoaneurysm managed with endovascular stent graft. Surg Laparosc Endosc Percutan Tech 2009;19:e106-8.  Back to cited text no. 3
    
4.Stefañczyk L, Elgalal MT, Chrz¹stek J, Szubert W, Czeczotka J, Papiewski A, et al. Pancreatitis-related abdominal aortic pseudoaneurysms treated with stent-grafts. Ann Vasc Surg 2012;26:730.e7-11.  Back to cited text no. 4
    




 

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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
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