Management of Pancreas-Related Vascular Abnormalities: A Case Series

Purpose: To present a series of cases illustrating a variety of endovascular techniques available for the management of pancreas-related vascular abnormalities in multiple clinical settings

Materials and Methods: Vascular complications secondary to acute on chronic pancreatitis, after pancreatic surgeries, trauma, and in the setting of pancreatic malignancies, may be life threatening and difficult to treat surgically. Abnormalities may involve the arteries and mesenteric veins adjacent to the pancreas and include postoperative bleeding from stump erosion, inflammatory pseudoaneurysms, and variceal bleeds secondary to venous stenosis and occlusion. Endovascular treatment has rapidly become an attractive, minimally invasive option to treat these abnormalities in patients who are poor surgical candidates. A case series of pancreas-related vascular abnormalities is presented to demonstrate endovascular treatment options available in multiple clinical settings.

Results: The cases presented include pseudoaneurysms of the arteries around the pancreas in the setting of acute on chronic pancreatitis, postoperative stump erosions, and venous stenosis and occlusions associated with pancreatitis and pancreatic malignancies. Arterial, venous, and percutaneous transhepatic and transjugular accesses were used to treat these patients. Procedures included covered stent placement to treat stump erosion following Whipple surgery; percutaneous transhepatic portal vein access to recanalize the chronically occluded superior mesenteric vein and subsequent stent placement; endograft placement at the confluence of the celiac and common hepatic arteries for postoperative common hepatic pseudoaneurysm; TIPS access to treat severe portal and superior mesenteric vein (SMV) stenosis followed by stenting of the portal vein, thrombectomy of the partially occluded SMV, and coiling of the associated duodenal varices; and multiple cases of coil embolization of left gastric, right gastric, and gastroduodenal artery pseudoaneurysms.

Conclusions: Pancreas-related vascular abnormalities occur in various clinical settings. These patients usually have multiple comorbidities and are not ideal surgical candidates. The minimally invasive nature of endovascular procedures makes them an attractive first-line treatment in these critically ill patients. This exhibit aims to familiarize the audience with various access options and techniques available to deal with this difficult cohort of patients.