Sections

Workup

Angiography

Angiography is the criterion standard for determining diagnosis and treatment (see the image below). Digital subtraction angiography (DSA) provides high-resolution imaging of small arteries and allows percutaneous vascular intervention in the same setting.^[15]

Splenic artery angiogram demonstrating contrast (white arrow) extravasating into a pseudoaneurysm (black arrow).

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If the patient is hemodynamically stable, performing a preoperative angiogram helps to confirm the diagnosis. Angiography defines the character—unique or otherwise—of the lesion and allows therapeutic planning. Angiography greatly facilitates identification of the location and serves as a topographic guide to the pseudoaneurysm, thereby aiding in operative proximal and distal control of the bleeding vessel.

Preoperative angiography may constitute an opportunity to gain temporary control over the bleeding vessel by performing transcatheter embolization, thus providing a time window within which the surgeon can operate on a high-risk patient under optimum clinical conditions.^[16]

CTA and MRA

Computed tomography (CT) angiography (CTA) has a sensitivity of up to 94.7% and a specificity of 90%. (See the image below.)^[17]

A CT scan with intravenous contrast enhancement (arrow) within a pancreatic pseudocyst indicating the presence of a pseudoaneurysm.

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Magnetic resonance angiography (MRA) is highly sensitive and specific. Limitations of MRA include its long study time, limited availability, high cost, and restricted utility for patients with certain implantable devices and hardware.

Treatment & Management

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Media Gallery

Splenic artery angiogram demonstrating contrast (white arrow) extravasating into a pseudoaneurysm (black arrow).
A CT scan with intravenous contrast enhancement (arrow) within a pancreatic pseudocyst indicating the presence of a pseudoaneurysm.
Preembolization angiogram depicting a splenic artery pseudoaneurysm.
Postembolization angiogram depicting successful coil embolization of a pseudoaneurysm.

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Author

Faisal Aziz, MD Assistant Professor of Surgery, Divsion of Vascular and Endovascular Surgery, Department of Surgery, Pennsylvania State University College of Medicine

Faisal Aziz, MD is a member of the following medical societies: American College of Surgeons, American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

John A Savino, MD Professor of Surgery, Chairman, Director of Residency Program, Department of Surgery, New York Medical College; Director of Surgical Critical Care Fellowship, Director of Surgical Intensive Care Unit, Attending Surgeon, Westchester Medical Center

John A Savino, MD is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, American Medical Association, Association for Academic Surgery, Association for Surgical Education, Medical Society of the State of New York, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Critical Care Medicine, Eastern Association for the Surgery of Trauma, Surgical Infection Society

Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, MSc, DSc, AGAF Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, Professor, Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow; Fellow of the Royal Society of Medicine

John Geibel, MD, MSc, DSc, AGAF is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Acknowledgements

Michael A Grosso, MD Consulting Staff, Department of Cardiothoracic Surgery, St Francis Hospital

Michael A Grosso, MD is a member of the following medical societies: American College of Surgeons, Society of Thoracic Surgeons, and Society of University Surgeons,

Disclosure: Nothing to disclose.

Mazen S Itani, MD, FACS Private Practice in Vascular Surgery, Hackettstown Regional Medical Center

Mazen S Itani, MD, FACS is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Alex Jacocks, MD Program Director, Professor, Department of Surgery, University of Oklahoma School of Medicine

Disclosure: Nothing to disclose.

Nabil Sumrani, MD Associate Professor, Department of Surgery, Division of Transplantation Surgery, State University of New York Health Science Center at Brooklyn

Nabil Sumrani, MD is a member of the following medical societies: Central Surgical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Pancreatic Pseudoaneurysm Workup

Angiography

CTA and MRA

References

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