Hepatic artery pseudoaneurysm coiling

Case contributed by Dr Paresh K Desai

Presentation

Acute on chronic pancreatitis with upper GI bleed

Patient Data

Age: 50 years
Gender: Male
DSA (angiography)

Fairly large pseudoaneurysm arising inferomedially at the common hepatic artery trifurcation. The left hepatic artery is taking off superomedially opposite the gastroduodenal. It has a narrow neck.

The celiac axis had a right angle take off from the aorta. Hence a Sim 1 catheter is used to cannulate the celiac axis. After confirming the presence of a narrow-necked pseudoaneurysm arising from the common hepatic artery trifurcation. The pseudoaneurysm is super selectively cannulated with a Progreat (Terumo) microcatheter. Microcoils (Hilal, COOK - ). 18", 3mmx30mm coils are deployed at the neck of the pseudoaneurysm.

Complete exclusion of the pseudoaneurysm is achieved.

One of the microcoil has migrated into the distal right hepatic arterial branch.

Case Discussion

Splanchnic pseudoaneurysms are a rare complication of pancreatitis. These patients may present with upper GI bleed, abdominal pain, etc.

Endovascular coiling is an effective method of treatment of these pseudoaneurysms.

Acknowledgments to Dr. Kapil Naik; my colleague in IR work.

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