Hepatic artery pseudoaneurysm after pancreaticoduodenectomy treated with coil embolization in combination with portomesenteric venous stenting

Abstract

Delayed massive hemorrhage after pancreaticoduodenectomy is known as a fatal complication, frequently caused by gastroduodenal artery stump bleeding or hepatic artery pseudoaneurysm. Transarterial hepatic artery embolization is one of the treatment options in such cases. However, hepatic artery embolization can also result in ischemic complications of the liver, even fatal sometimes. We report a case of a 70-year-old male patient with distal common bile duct cancer who underwent pancreaticoduodenectomy. After three weeks, there was a bloody drain component accompanied with a decreased hemoglobin level. The immediate computed tomography scan and subsequent angiography demonstrated a hepatic artery pseudoaneurysm (1.8 cm in size) with segmental narrowing of the portal vein and superior mesenteric vein. The pseudoaneurysm and common hepatic artery were embolized using microcoils, following percutaneous portomesenteric stenting. There was no such ischemic complication as hepatic infarction after the procedure, and the patient was well tolerable. We suggest that the simultaneous portomesenteric stenting prior to hepatic artery embolization may be helpful to reduce the risk of hepatic infarction/failure in a patient with hepatic artery pseudoaneurysm accompanying portomesenteric vein stenosis after pancreaticoduodenectomy.

Keywords

• aneurysm, false
• liver failure
• mesenteric vein
• pancreaticoduodenectomy
• therapeutic embolization