J Korean Soc Radiol.  2014 Oct;71(4):173-177. 10.3348/jksr.2014.71.4.173.

Percutaneous N-Butyl Cyanoacrylate Embolization of a Pancreatic Pseudoaneurysm after Failed Attempts of Transcatheter Embolization

• Kim RH
• Yoo RE
• Kim HC

• KMID: 2098001
• DOI: http://doi.org/10.3348/jksr.2014.71.4.173

Abstract

One common complication after major pancreatic surgery is bleeding. Herein we describe a case of pancreatic pseudoaneurysm which developed after pylorous preserving pancreaticoduodenectomy for common bile duct cancer. Three attempts of transcatheter embolization failed since feeders to the pseudoaneurysm had unfavorable anatomy. Direct percutaneous N-butyl cyanoacrylate injection was performed under fluoroscopy-guidance and the pseudoaneurysm was successfully treated. Percutaneous fluoroscopy-guided direct N-butyl cyanoacrylate injection may be a useful alternative when selective transcatheter embolization fails or is technically challenging.

MeSH Terms

Aneurysm, False*
Common Bile Duct
Cyanoacrylates*
Hemorrhage
Pancreaticoduodenectomy
Cyanoacrylates

Figure

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  Fig. 1 The contrast-enhanced abdominal CT scan (arterial phase) taken 16 days after pylorous preserving pancreaticoduodenectomy for common bile duct cancer shows a 6.2-mm pseudoaneurysm (arrow). The extent of hematoma between the pancreas and the stomach (arrowhead) was slightly decreased after insertion of a drainage catheter (not shown).

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  Fig. 2 Angiography was performed 16 days after pylorous preserving pancreaticoduodenectomy. A. Celiac angiography shows a pseudoaneurysm at the dorsal pancreatic artery (arrow). B. Selective angiography of the dorsal pancreatic artery demonstrates the pseudoaneurysm (arrow) connected with several small pancreatic branches.

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  Fig. 3 The 3rd trial of transcatheter embolization was performed 24 days after pylorous preserving pancreaticoduodenectomy. A. Superior mesenteric angiography at the second attempt reveals a feeding vessel to the pseudoaneurysm (arrow). B. Selective angiography of the pancreaticoduodenal artery from the superior mesenteric artery shows that the feeding vessel of the pseudoaneurysm (arrow) is very tortuous and angulated.

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  Fig. 4 Percutaneous fluoroscopy-guided direct N-butyl cyanoacrylate injection was performed 24 days after pylorous preserving pancreaticoduodenectomy. A. Direct percutaneous puncture of the pseudoaneurysm (arrow) was carried out under fluoroscopic guidance. B. The post-procedural fluoroscopic image shows compact filling of N-butyl cyanoacrylate in the pseudoaneurysm (arrow) as well as vessels (arrowheads) connected with the pseudoaneurysm.

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  Fig. 5 The follow-up contrast-enhanced CT scan taken seven days after the embolization demonstrates compact filling of the pseudoaneurysm (arrow) with the NBCA and iodized oil mixture. CT scan 18 months after the procedure showed no recurrence of pseudoaneurysm (not shown).

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