“Post pancreatectomy hemorrhage (PPH) is a rare but fatal complication with reported mortality rates of 16%-50%. It is associated with significant morbidity and mortality, especially when repeat laparotomy is required to control bleeding. Among the causes of PPH, intraabdominal pseudoaneurysm is directly associated with prolonged hospital stay and death due to sudden hemorrhage. An aneurysm is a localized dilatation of the artery and can either be true aneurysm (involves all the 3 arterial layers) or pseudoaneurysm (lack a complete arterial wall or surrounded by soft tissue). An arterial leak is an extravasation or a persistent blood flow following arterial anastomosis or arterial repair into the aneurysm sac. The cause of post-PD pseudoaneurysms is described to be multifactorial. However, it is well known that pancreatic fistula is mostly associated with the development of pseudoaneurysm. Other factors predisposed for its development include iatrogenic trauma of vessel walls during lymphadenectomy, biliary fistula, mechanical irritations by
drainage tubes, and intra-abdominal infections that destroy the vessel wall.”
“The prevalence of post-PD pseudoaneurysm in our study was 4.9%, which was comparable to those reported in other studies, at 2%e12%. Despite its low prevalence, it is associated with high mortality and morbidity. This study aimed to develop a prediction criterion to determine the development of pseudoaneurysm post-PD, its optimal management, factors associated with patient death, and rupturing of the pseudoaneurysm. This was sought by retrospectively evaluating the database of 453 post-PD patients and identifying the risk factors using multivariate analysis. Our comprehensive study found the following significant information that is not currently available in other published literature: the median time period for the diagnosis of pseudoaneurysm post-PD was 17 days, and the independent risk factors for pseudoaneurysm formation after PD were younger age, prolonged operation time, and POPF grade B or C. Furthermore, mortality after
pseudoaneurysm rupture post-PD was significantly associated with a prolonged operating time. Further subgroup analyses revealed that the risk factors associated with pseudoaneurysm formation were different between the PDAC and non-PDAC patients: pro-
longed operating time in PDAC patients and high BMI in non-PDAC patients.”
Chipaila, Jackson et al. “Prolonged operating time is a significant perioperative risk factor for arterial pseudoaneurysm formation and patient death following hemorrhage after pancreaticoduodenectomy.” Pancreatology : official journal of the International Association of Pancreatology (IAP) … [et al.] vol. 20,7 (2020): 1540-1549. Full Text for Emory Users
