Endoscopic Ultrasound-Guided Thrombin Injection for the Treatment of Pancreatic Pseudoaneurysm

Introduction

A pseudoaneurysm is a contained leak from an artery which remains in communication with the arterial lumen. Pseudoaneurysm formation is an uncommon but well-recognised complication of pancreatitis [1]. It is associated with a mortality of up to 50 % [1], or over 90 % if leaking or ruptured and untreated [2]. Conventional treatment is surgical ligation but, more recently, treatment strategies that utilise interventional radiological techniques such as angiographic embolisation have been developed to treat pseudoaneurysms. These techniques require selective catheterisation of the vessel supplying the pseudoaneurysm and its occlusion with coils or other thrombogenic agents.

Thrombin injection directly into pseudoaneurysms is a technique which was developed to treat pseudoaneurysms that formed following femoral artery puncture, with a success rate of up to 97 % [2]. More recently, direct percutaneous thrombin injection into pancreatitis-induced pseudoaneurysms, guided either by ultrasound [2] [3] [4] or by computed tomography [1], has been described.

The use of endoscopic ultrasound (EUS) in the diagnosis of pseudoaneurysms secondary to pancreatitis has been reported [5] [6]. In this report, we describe the injection of thrombin into a superior mesenteric artery pseudoaneurysm under EUS guidance. As far as we are aware, this technique has not been reported previously.

References

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