Endovascular Management of Pseudoaneurysms and Aneurysms Following Gastrointestinal Surgery

Abstract

1. Abstract 1.1. Purpose: This study aimed to evaluate the characteristics of pseudoaneurysms and aneurysms following gastrointestinal surgery treated with endovascular management (i.e., transcatheter arterial embolization or stent-graft placement). 1.2. Methods: This retrospective study included 17 patients with pseudoaneurysms and 1 patient with an aneurysm following gastrointestinal surgery in a tertiary care hospital between 2011 and 2021. There were 15 men and 3 women aged 37–85 years, with an average age of 67 years. All patients underwent endovascular management. We retrospectively analyzed their angiographic features and clinical outcomes. 1.3. Results: Arterial embolization was performed in 11 patients, and stent-graft placement was performed in 7 patients. Additional arterial embolization was necessary for another bleeding lesion in 2 patients, while 1 patient died of multiple organ failure. Stent-graft occlusion occurred after a few days in 3 out of 7 patients without any antithrombotic drugs. Extravascular migration of the occluded stentgrafts was observed in 3 out of 7 patients, wherein these stent-grafts migrated to the intestine and eventually disappeared in 2 patients. There were no clinical symptoms related to the occlusion or migration of the stent-grafts. 1.4. Conclusion: Both arterial embolization and stent-graft placement are effective in the management of postoperative pseudoaneurysms and aneurysms. Stent-graft placement is suitable for cases with poor collateral flow because it preserves arterial patency. The use of antithrombotic treatment and the risk of stent-grafts migration should be taken into consideration. 2. Introduction Traditionally, surgical treatment is considered the first-line approach for pseudoaneurysms and aneurysms. Recently, less invasive techniques have been developed, such as Transcatheter Arterial Embolization (TAE) and stent-graft placement. This study aimed to review our experience on the treatment of pseudoaneurysms and an aneurysm following gastrointestinal surgery and to evaluate the effectiveness of endovascular management. 3. Materials and Methods 3.1. Study Design and Patients We retrospectively reviewed 17 patients with pseudoaneurysms and 1 patient with aneurysm following gastrointestinal surgery between January 2011 and May 2021 at our hospital. There were 15 men and 3 women with an average age of 67 years (range 37–85 years). The following clinical information were also analyzed: primary disease, surgical procedure, postoperative complications and bacterial culture results prior to bleeding, interval from operation to bleeding, symptoms, interval from detection of bleeding via computed tomog-