Visceral artery pseudoaneurysm in necrotizing pancreatitis: incidence and outcomes

Background: Visceral artery pseudoaneurysms (VA-PSA) occur in necrotizing pancreatitis; however, little is known about their natural history. This study sought to evaluate the incidence and outcomes of VA-PSA in a large cohort of patients with necrotizing pancreatitis. Methods: Data for patients with necrotizing pancreatitis who were treated between 2005 and 2017 at Indiana University Health University Hospital and who developed a VA-PSA were reviewed to assess incidence, presentation, treatment and outcomes. Results: Twenty-eight of 647 patients with necrotizing pancreatitis (4.3%) developed a VA-PSA between 2005 and 2017. The artery most commonly involved was the splenic artery (36%), followed by the gastroduodenal artery (24%). The most common presenting symptom was bloody drain output (32%), followed by incidental computed tomographic findings (21%). The median time from onset of necrotizing pancreatitis to diagnosis of a VA-PSA was 63.5 days (range 1-957 d). Twenty-five of the 28 patients who developed VA-PSA (89%) were successfully treated with percutaneous angioembolization. Three patients (11%) required surgery: 1 patient rebled following embolization and required operative management, and 2 underwent upfront operative management. The mortality rate attributable to hemorrhage from a VA-PSA in the setting of necrotizing pancreatitis was 14% (4 of 28 patients). Conclusion: In this study, VA-PSA occurred in 4.3% of patients with necrotizing pancreatitis. Percutaneous angioembolization effectively treated most cases; however, mortality from VA-PSA was high (14%). A high degree of clinical suspicion remains critical for early diagnosis of this potentially fatal problem. Contexte : Les faux anevrismes des arteres viscerales (FAAV) surviennent en presence d'une pancreatite necrosante; on en sait cependant peu sur leur histoire naturelle. L'objectif de l'etude etait d'evaluer l'incidence et les issues des FAAV dans une grande cohorte de patients atteints de pancreatite necrosante. Methodes : Nous avons examine les donnees des patients atteints de pancreatite necrosante traites entre 2005 et 2017 a l'Hopital universitaire de l'Universite de l'Indiana qui ont fait un FAAV afin d'evaluer l'incidence, les premiers signes, le traitement et les issues de cette affection. Resultats : Vingt-huit (4,3 %) des 647 patients atteints de pancreatite necrosante inclus (2005-2017) ont fait un FAAV. L'artere la plus souvent touchee etait l'artere splenique (36 %), suivie de l'artere gastroduodenale (24 %). Les premiers signes les plus courants etaient la presence de sang dans les liquides evacues par drainage (32 %), puis les resultats d'une tomodensitometrie effectuee pour une autre raison (21 %). Le delai median entre l'apparition de la pancreatite necrosante et le diagnostic de FAAV etait de 63,5 jours (intervalle : 1 a 957 jours). Vingt-cinq des 28 patients ayant fait un FAAV (89 %) ont ete traites avec succes par angioembolisation percutanee. Trois patients (11 %) ont du etre operes : 2 des le debut, et le troisieme parce qu'il a recommence a saigner apres l'embolisation. Le taux de mortalite par hemorragie due a un FAAV chez les personnes atteintes d'une pancreatite necrosante etait de 14 % (4 patients sur 28). Conclusion : Dans cette etude, 4,3 % des patients atteints de pancreatite necrosante ont connu un FAAV. L'angioembolisation percutanee s'est averee efficace dans la plupart des cas; cependant, la mortalite associee aux FAAV etait elevee (14 %). Il est crucial de faire preuve d'une grande suspicion clinique afin de diagnostiquer tot cette affection potentiellement mortelle.
Avisceral artery pseudoaneurysm (VA-PSA) is a known complication following pancreatic surgery as well as in the setting of acute and chronic pancreatitis. A VA-PSA formation can lead to massive hemorrhage [...]