Treatment of a Pancreatic Pseudoaneurysm with Percutaneous image-guided Transhepatic Thrombin Injection – Case Report

Introduction

Pancreatic pseudoaneurysms represent a rare but life-threatening vascular complication of both acute and chronic pancreatitis. The Society for Vascular Surgery and CIRSE (Cardiovascular and Interventional Radiological Society of Europe) underscore the necessity of prompt and definitive treatment for both symptomatic and non-symptomatic, aneurysms and pseudoaneurysms of pancreaticoduodenal and gastroduodenal arteries, regardless of size or anatomical location [1] [2]. Pathogenesis is most commonly linked to arterial wall erosion, typically of a peripancreatic or pancreatic artery, frequently resulting in hemorrhage into a pseudocyst, although pseudocyst formation is not a prerequisite for pseudoaneurysm development [3].

The incidence of pseudoaneurysms is estimated to range between 4–17% in patients with chronic or necrotizing pancreatitis. Hemorrhagic complications occur in 5–10% of cases, but this risk increases to 15–20% in the presence of a pseudocyst. If left untreated, pseudoaneurysms carry a mortality rate exceeding 90%, making early diagnosis and intervention critical [3].

From a diagnostic perspective, contrast-enhanced computed tomography (CT) and digital subtraction angiography (DSA) remain the modalities of choice. While CT offers valuable insight into associated pancreatic necrosis, angiography provides both high diagnostic specificity and the opportunity for immediate therapeutic intervention via embolization or stent placement. Differential diagnosis should include a range of hypervascular lesions, such as cystic neoplasms, abscesses, mesenteric cysts, hydatid disease, and aortic aneurysms [4].

Therapeutic strategies include surgical resection, transarterial embolization (TAE), and, more recently, percutaneous thrombin injection. Surgical management, particularly for lesions located in the pancreatic head, is technically demanding and associated with significant morbidity and a postoperative mortality rate of 20–30%. It is understood that the invasiveness of surgery and its associated complications have led to a shift in favour of radiological interventions (transarterial embolization, TAE), percutaneous thrombin injection) as the preferred initial treatment [5]. However, recurrence rates remain notable, and overall mortality following embolization may reach up to 16% [3].

While treatment options are limited this case report describes the successful approach in an alcoholic male patient with a pancreatic pseudoaneurysm using a percutaneous transhepatic thrombin injection after failing transarterial embolization.

Publikationsverlauf

Eingereicht: 29. Juni 2025

Angenommen nach Revision: 11. September 2025

Artikel online veröffentlicht:
30. September 2025

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