Hepatic Artery Pseudoaneurysm Rupture with Acute Portal Vein Occlusion Treated with Coronary Stent Graft and Trans-splenic Portal Vein Stenting

Abstract

Delayed massive hemorrhage following pancreaticoduodenectomy is a potentially fatal condition. These patients are often not surgical candidates, and endovascular therapy is the primary option of treatment, usually trans-arterial embolization. However, the bleeding vessel can occasionally be treated with a stent graft rather than embolization. This decreases the risk of hepatic necrosis by preserving hepatic arterial blood flow, particularly in patients with compromised portal veins. The authors present a brief case report of delayed pseudoaneurysm rupture from a replaced proper hepatic artery after pancreaticoduodenectomy with resultant portal vein occlusion, caused by hematoma mass effect. The hepatic artery was treated with a coronary stent. During the same session, trans-splenic portal vein stenting was done.

Keywords

pancreaticoduodenectomy - pseudoaneurysm - bleeding - stent graft

• References

• 1 de Castro SM, Kuhlmann KF, Busch OR. et al. Delayed massive hemorrhage after pancreatic and biliary surgery: embolization or surgery?. Ann Surg 2005; 241 (01) 85-91
• 2 Ding X, Zhu J, Zhu M. et al. Therapeutic management of hemorrhage from visceral artery pseudoaneurysms after pancreatic surgery. J Gastrointest Surg 2011; 15 (08) 1417-1425
• 3 Asai K, Watanabe M, Kusachi S. et al. Successful treatment of a common hepatic artery pseudoaneurysm using a coronary covered stent following pancreatoduodenectomy: report of a case. Surg Today 2014; 44 (01) 160-165
• 4 Hasegawa T, Ota H, Matsuura T. et al. Endovascular treatment of hepatic artery pseudoaneurysm after pancreaticoduodenectomy: risk factors associated with mortality and complications. J Vasc Interv Radiol 2017; 28 (01) 50-59.e5
• 5 Briguori C, Nishida T, Anzuini A, Di Mario C, Grube E, Colombo A. Emergency polytetrafluoroethylene-covered stent implantation to treat coronary ruptures. Circulation 2000; 102 (25) 3028-3031
• 6 Muraoka N, Uematsu H, Kinoshita K. et al. Covered coronary stent graft in the treatment of hepatic artery pseudoaneurysm after liver transplantation. J Vasc Interv Radiol 2005; 16 (02) Pt 1 300-302
• 7 Wang MQ, Liu FY, Duan F, Wang ZJ, Song P, Fan QS. Stentgrafts placement for treatment of massive hemorrhage from ruptured hepatic artery after pancreaticoduodenectomy. World J Gastroenterol 2010; 16 (29) 3716-3722