Studying outcomes of visceral artery pseudoaneurysm in necrotizing pancreatitis

University of Minnesota Medical School researchers have aimed to evaluate the incidence, clinical presentation, management, and outcomes of visceral artery pseudoaneurysm (PSA) in necrotizing pancreatitis (NP). The results are published in Gastrointestinal Endoscopy.

The retrospective study used data from past patients to find better outcomes for people suffering from NP. Researchers say if doctors looked for and treated pseudoaneurysms earlier, a better outcome could be found.

"Although visceral artery PSA affects a small percentage of NP patients, it is associated with significant morbidity and mortality. In addition, bleeding from PSA induced by erosion of lumen-apposing metal stents (LAMS) may occur in the first two weeks, prompting individualization of removal intervals," said lead researcher and U of M Medical School Fellow Mohamed Abdallah, MD.

This study describes the largest cohort of patients with PSA in the setting of NP ever published. Key findings include:

• 6.4% of patients with NP seen at the University of Minnesota were found to have PSA.
• Endoscopic and percutaneous drainages for walled-off necrosis (WON) were more common in patients with PSA compared to patients without PSA.
• Seven patients developed PSA without any intervention for WON. 17 patients (43.6%) had lumen-apposing metal stents (LAMSs) placed before PSA diagnosis.
• The time from NP to PSA diagnosis was shorter in these patients than in the remaining patients.
• Seven of 11 patients (63.6%) with early PSA had an indwelling LAMS at the time of the PSA diagnosis.
• In-hospital mortality was observed in 23.1% of patients.

Although there is an increased incidence of PSA in the setting of NP, its incidence is not impacted by the severity of AP, presence of organ failure, and infected necrosis. An earlier incidence of PSA is known to occur in the endoscopic-centered approach, particularly in those managed by LAMSs, which warrants earlier follow-up imaging. Researchers say with a timely diagnosis, patients may be treated with a higher chance of excellent outcomes.