ENDOSCOPIC ULTRASOUND-GUIDED ANGIOTHERAPY USING COIL AND CYANOACRYLATE GLUE FOR THE MANAGEMENT OF VISCERAL ARTERY PSEUDOANEURYSMS IN PATIENTS OF PANCREATITIS: A SAFE AND EFFECTIVE TECHNIQUE

Aims Visceral artery pseudoaneurysms (PSA) can develop in patients with acute (AP) and chronic pancreatitis (CP) and EUS-guided angioembolisation (EUS-A) using coil and glue injection is a relatively newer modality with limited experience. This study aimed at studying the safety and efficacy of this modality for management of PSA in AP/CP patients.

Methods This study was conducted in a tertiary care center between September 2018-August 2021 including all consecutive AP or CP patients with visceral artery PSA, who were unsuitable for radiological angioembolisation. The patients underwent EUS-A using coil and cyanoacrylate glue (CYA) injection. The number of coils used and amount of CYA injected depended on the size of the PSA. PSA characteristics, technical success, and adverse events were documented.

Results A total of 15 patients (median age 44.0 (17-56) yrs; male 14; 93.3%) with 16 PSA underwent EUS-A. Most of the patients had underlying CP (12; 80.0%). The vessel involved was splenic artery in 12 (75.0%) followed by gastroduodenal artery (4;25.0%). The median size of the PSA was 2.8 cm (0.9–9.7 cm). A median of 2 coils (1-8) and 2 ml of CYA (1-5 ml) was used. Complete obliteration in the first session was achieved in 15 PSA (93.8%). One patient had recurrence of PSA in the splenic artery 9 months post-procedure and was managed with repeat EUS-A. 1 patient developed splenic infarct post-embolization and managed conservatively. No other complications were documented.

Fig. 1

Conclusions EUS-guided coil and CYA injection is a safe and effective alternative technique for the management of visceral artery PSA.

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Artikel online veröffentlicht:
14. April 2022