| Article Access Statistics | | | Viewed | 5127 | | | Printed | 72 | | | Emailed | 0 | | | PDF Downloaded | 12 | | | Comments | [Add] | | |
|
Click on image for details.
|
|
 |
| LETTER |
|
|
|
| Year : 2012 | Volume
: 58
| Issue : 4 | Page : 328 |
Endovascular management in aortic pseudoaneurysms caused by acute pancreatitis
S Srinivasan, SB Babu
Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore
| Date of Web Publication | 4-Jan-2013 |
Correspondence Address:
S Srinivasan
Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central
Singapore
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0022-3859.105474
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 |
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 | |  |
| 1. | Subhash R, Iyoob VA, Bonny N. Complicated acute pancreatitis: The worst-case scenario. J Postgrad Med 2012;58:154-5. 
[PUBMED]  |
| 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.
[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.
|
| 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.
|
|
