search for




 

Successful Simultaneous Endovascular Repair of Traumatic Portal Vein Pseudoaneurysm and Aortic Injury
J Acute Care Surg 2018;8:83−85
Published online October 30, 2018;  https://doi.org/10.17479/jacs.2018.8.2.83
© 2018 Korean Society of Acute Care Surgery.

Seon Uoo Choi*, Seon Hee Kim*, Sung Jin Park*, Chan Ik Park*, Up Huh, Seunghwan Song, Chang Won Kim, and Hyuk Jin Choi§
Seon Hee Kim, M.D. Department of Trauma Surgery, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea Tel: +82-51-240-7369, Fax: +82-51-240-7719, E-mail: ksh810427@naver.com ORCID: http://orcid.org/0000-0002-9756-9652
Received September 18, 2018; Revised October 1, 2018; Accepted October 1, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Body

A 50-year-old man visited to the trauma center after driver traffic accident. Multiple injuries were found on computed tomography (CT) scan including aortic injury, duodenal perforation, pancreas contusion, and portal vein aneurysm (Fig. 1). Exploratory laparotomy was performed immediately for control of bleeding, primary repair of perforated duodenum, transverse colon and stomach. As soon as the operation was completed, the patient was transferred to the angio-room. The endovascular repair for aorta and portal vein was performed (Fig. 2). The patient was discharged from the hospital 3 months later, without disability and complication. At 1-year follow up CT scan revealed no endoleak and good patency of stent-graft (Fig. 3).

Fig. 1.

Initial computed tomography (CT) scan. (A) Contrast enhanced CT scan of the chest revealed a 3 cm long pseudoaneurysm at the isthmus of the aorta (arrow) and intramural hematoma in the descending thoracic aorta. (B) Venous phase image of the abdominal CT scan demonstrates a 2 cm portal vein aneurysm (arrow) and hematoma around the pancreas head.


Fig. 2.

Endovascular repair. (A, B) Transhepatic portography shows a portal vein pseudoaneurysm just proximal to the joining of the superior mesenteric vein (SMV) and splenic vein. (C) Viabahn stent graft (W.L. Gore, Flagstaff, Ariz) in SMV and portal vein.


Fig. 3.

Three-dimensional aorta angiography 1-year postoperative. (A) Transendovascular aortic repair indicated a complete resorption of the traumatic aortic dissection. (B) Stent graft insertion in the portal vein indicated good patency and no endoleak. Embolization of the traumatic pseudoaneurysm of the midcolic artery showed no extravasation or bowel ischemic change


Traumatic aortic injury (TAI) is the second most common cause of death from blunt trauma. Paradigm of TAI treatment has changed from open surgery to endovascular repair because of the benefits of minimal invasiveness and avoidance of full heparinization in multiple trauma patients [1]. Although pseudoaneurysm of the post-traumatic portal vein rarely occurs, surgical mortality is also high because of the difficulty in maintaining hemostasis and the secondary damages associated with enteric and pancreatic injuries [2,3]. Combined angiographic and surgical approaches could provide advantages for exsanguinating patients with multiple injuries and especially for management of major vascular, high-grade liver, or pelvic bleeding [4,5]. We achieved a good result through combined endovascular open surgical treatment in the patient who required the management of damage control resuscitation.

Acknowledgments

This work was supported by clinical research grant from Pusan National University Hospital in 2017.

Conflicts of Interest

No potential conflict of interest relevant to this article was reported.

References
  1. Ball CG, Kirkpatrick AW, and D'Amours SK. The RAPTOR:resuscitation with angiography, percutaneous techniques and operative repair. Transforming the discipline of trauma surgery. Can J Surg 2011;54:E3-4.
    Pubmed KoreaMed
  2. Pachter HL, Drager S, Godfrey N, and Lefleur R. Traumatic injuries of the portal vein. The role of acute ligation. Ann Surg 1979;189:383-5.
    Pubmed KoreaMed
  3. Laopaiboon V, Aphinives C, Pugkem A, Thummaroj J, Puttharak W, and Soommart Y. Selective transcatheter embolization for treatment of post-traumatic hepatic artery and portal vein pseudoaneurysms. J Med Assoc Thai 2006;89:248-52.
    Pubmed
  4. Hoffer EK, Borsa JJ, Bloch RD, and Fontaine AB. Endovascular techniques in the damage control setting. Radiographics 1999;19:1340-8.
    Pubmed CrossRef
  5. Gruen RL, Brohi K, Schreiber M, Balogh ZJ, Pitt V, and Narayan M et al. Haemorrhage control in severely injured patients. Lancet 2012;380:1099-108.
    CrossRef


October 2018, 8 (2)
Full Text(PDF) Free


Cited By Articles
  • CrossRef (0)
Social Network Service
Services