Experience On The Diagnosis And Treatment Of Postoperative Pseudoaneurysm: A Report Of 6 Cases

Objective:To sum up experience on the diagnosis and treatment of postoperative pseudoaneurysm.Material and Method:Medical records of pseudoaneurysm patients who were diagnosed by digital subtraction angiography (DSA) from Jan.2006 to Dec.2010 in our department were evaluated retrospectively. The operation histories, complications, clinical features of pseudoaneurysm, the time of diagnosis, and management strategies of these cases were analyzed.Results:There were 6 cases of pseudoaneurysm which were treated successfully in our department in recent 5 years. The previous operative procedures were pancreaticoduodenectomy (2 cases), distal radical gastrectomy (1 case), laparoscopic cholecystectomy (1 case), left lateral hepatic lobectomy + plastic procedure of biliary-enteric anastomosis + exploration of common bile duct + T-tube drainage (1 case), repair of the right iliac vein + resection of partial ileum + repair and ostomy of bladder (1 case). The sites of pseudoaneurysms were left superior gluteal artery, square lobe hepatic artery, proper hepatic artery, common hepatic artery, right hepatic artery, left gastric artery. The time between previous operation and diagnosis of pseudoaneurysm was from 16 days to 23 months. The major clinical features of pseudoaneurysm were pain and bleeding. Two patients were directly diagnosed by DSA and treated by embolization after abdominal pain or bleeding; three patients were firstly treated by surgery after bleeding from abdominal cavity or GI track, then they were diagnosed by DSA and treated by embolization after re-bleeding; one patient's the severe pain of lower limb didn't improve after a negative laparotomy in another hospital, then he was treated by embolization after diagnosed as pseudoaneurysm by DSA in our department. None of the patients recurred after embolization.Conclusion:Postoperative pseudoaneurysm is a rare but severe complication; the major clinical features are pain and bleeding; DSA often leads to diagnosis of pseudoaneurysm correctly and timely; embolization is the first choice of treatment; reducing tissue injury during operation is the key to prevent the occurrence of pseudoaneurysm.