Visceral artery pseudoaneurysm: Is EUS-guided treatment ready for prime time?

摘要

Once upon a time … there was a bleeding visceral artery pseudoaneurysm. This extremely rare condition, with an incidence of 0.01 % to 0.2 %, usually occurs after vascular injuries or erosions such as in trauma or inflammation . The leading cause is represented by chronic pancreatitis (CP). Sixty-eight percent of visceral artery pseudoaneurysms are secondary to pancreatitis and pseudocyst formation, with up to 17 % of patients with chronic pancreatitis developing pseudoaneurysms. Although prevalence of a pseudoaneurysm in CP is not high, in three of four cases it may bleed, either into the gastrointestinal tract or pancreatic duct, simulating upper gastrointestinal bleeding, or directly into the peritoneal or retroperitoneal cavity, with potentially catastrophic outcomes. Indeed, in the setting of complicated chronic pancreatitis, bleeding has high morbidity and mortality. True visceral aneurysms, in which all three layers are involved, have very low risk of bleeding. False or pseudo-aneurysms arise from a breach of the inner-wall layers, resulting in bulging of the adventitial layer, and carry a very high risk of rupture .