Endovascular micro-arterial stenting for arterial pseudoaneurysm after pancreatic surgery

Although arterial pseudoaneurysm is one of the most serious complications after pancreatic surgery, the best practice with maximum efficacy and minimum adverse effects to overcome such a serious situation has not yet been elucidated. We performed endovascular micro-arterial stenting (EMAS) to manage this serious situation while preserving a sufficient hepatic arterial flow, and herein report the technical details and challenges of the procedure. Dilation of the stent using a balloon catheter to adhere to the parent artery, and embolization of the surrounding artery to prevent type I and type II endo-leaks are the most important points for ensuring a successful procedure. We applied this technique to 6 cases of hepatic arterial pseudoaneurysm, with a mean size of 6.5 ± 1.3 mm. The mean time of the procedure was 81 ± 22 min, without adverse events, including hepatic necrosis or arterial bleeding. EMAS may be the ideal procedure for treating pseudoaneurysm after pancreatic surgery while preserving the hepatic arterial inflow.