Salvage options after stent collapse in the thoracic aorta.

The endograft was originally developed to repair aneurismal disease of the infra-renal aorta and has since realised many other applications, including the treatment of arterial trauma. Traumatic transection of the thoracic aorta is a condition associated with a high mortality and affected patients often have multiple injuries. Endovascular repair of thoracic transection is an attractive option in those patients for whom open surgical repair would be highly dangerous and other groups have reported early technical success. However, we report 3 cases of young patients with traumatic thoracic aortic transection, initially treated successfully by endoluminal stenting, who developed the complication of stent collapse. We discuss here the options available to treat the complication.

Endovascular management of major arterial hemorrhage as a complication of inflammatory pancreatic disease.

PURPOSE: Major arterial hemorrhage is an important complication of inflammatory pancreatic disease, with an overall mortality of 37%. The present study was undertaken to evaluate the experience of a tertiary referral center for pancreaticobiliary disease in the management of major arterial complications of pancreatitis with selective visceral angiography and transcatheter arterial embolization (TAE). MATERIALS AND METHODS: A 6-year retrospective analysis of all patients undergoing visceral angiography for major bleeding as a complication of pancreatitis identified 35 patients (26 male, 9 female) with a mean age of 51.2 years (range, 11-73 y). Patient demographics, history, clinical presentation, angiographic findings, angiographic treatment, and follow-up outcomes were retrospectively noted. Technical success was defined as the devascularization of a focal lesion or reduction or cessation of blood flow to a target vascular bed or organ, and clinical success was defined as the resolution of the symptoms and signs that prompted the initial embolization. RESULTS: Angiography identified the site of bleeding in 54.3% of patients (n=19) and angiographic intervention was performed in 77.1% of patients (n=27). Technical success was achieved in 81.5% of those 27 patients (n=22), with overall clinical success in 80.0% (n=28). Multiple angiograms were required in 12 patients, with four demonstrating bleeding from new sites. The mortality rate was 20% (7 of 35). CONCLUSIONS: In major arterial hemorrhage resulting from pancreatic inflammatory disease, visceral angiography can identify the site of bleeding and hemostasis can be achieved. Repeat angiography is often required with bleeding from new sites. The mortality rate is comparable to that associated with surgery and reflects multisystem involvement in acute severe pancreatitis.

Multi-section CT angiography compared with digital subtraction angiography in diagnosing major arterial hemorrhage in inflammatory pancreatic disease.

PURPOSE: Major arterial hemorrhage is an uncommon but serious complication of pancreatitis with high morbidity and mortality. Digital subtraction angiography (DSA) has long been the gold standard for the detection of a visceral artery pseudoaneurysm or for the site of active bleeding in patients with pancreatitis. Multi-section CT angiography is a minimally invasive technique which can provide high-resolution and high-contrast images of the arterial lumen and wall, with a much lower risk of complication and morbidity compared to DSA. The aim of this study was to determine the accuracy of multi-section CT angiography for the diagnosis of arterial complications of inflammatory pancreatitic disease. MATERIALS AND METHODS: A retrospective analysis of all patients undergoing visceral angiography for major bleeding as a complication of pancreatitis between 1998 and 2004 was performed. Twenty-nine studies in 25 patients (20 males, 5 females) with a mean age of 50.9 years (range 11-67 years) were identified where multi-section CT angiography was performed in the 24 h preceding the digital subtraction angiogram. RESULTS: Digital subtraction angiography detected a pseudoaneurysm or contrast extravasation in 19 studies and no bleeding was demonstrated in 9 studies. CT angiography correctly identified the site and type of bleeding in 18 of the 19 positive studies. CT angiography detected extravasation of contrast in one study that was not demonstrated on digital subtraction angiography. The sensitivity and specificity for multi-section CT angiography for the detection of major arterial bleeding on a background of pancreatitis were 0.947 and 0.900, respectively. CONCLUSION: Multi-section CT angiography is a sensitive and accurate technique for the detection of major arterial hemorrhage in inflammatory pancreatic disease and should be considered as the first investigation in the management of these patients.