Acta chir belg, 2004, 104, 564-567 Report of three cases Case 1 A 68-year old man underwent a pancreaticoduodenecto- my because of an invasive adenocarcinoma of Vater’s papilla. After an uneventful postoperative course, the patient left the hospital 12 days after the operation, but at day 37, he was readmitted because of an episode of fever (38.5°C). An echography as well as a CT (com- puted tomography)-scan (Fig. 1) revealed a large pseudoaneurysm with a diameter of 5 cm, located dor- sally to the portal vein and caudally to the right liver lobe. Infiltration of the perianeurysmal fatty tissue was also noted, suggesting a contained rupture. No abscess, no other collection were detected. Because of the potential risk of rupture of that large pseudoaneurysm, the patient went to the angiography suite for percutaneous embolization. Under local anaes- thesia, a 5 F selective visceral catheter (Cobra-2 Glide Cath, Terumo Europe, Leuven, Belgium) was introduced via the right groin into the celiac trunk and the superior mesenteric artery. A large pseudoaneurysm was depict- ed postostially to the displaced right hepatic artery (Fig. 2a). Using a microcatheter (SP-microfocus, Terumo Europe, Leuven, Belgium) the right hepatic artery, distally to the pseudoaneurysm could be selec- tively catheterized. Fibered microcoils (Boston Scientific Target, Natick, MA, USA) were placed distal- ly (Fig. 2b) and proximally to the aneurysm, occluding the lesion by a “sandwich technique”. Completion angiography after embolization confirmed the total exclusion of the pseudoaneurysm (Fig. 2c) ; the end branches of the right hepatic artery were re-injected by collaterals coming from the left hepatic artery. The postembolization course was uneventful and the fever disappeared under antibiotic therapy. Control abdominal CT-scan 1 month and 1 year (Fig. 3) after the emboliza- tion procedure showed progressive decrease of the vol- ume of the completely thrombosed pseudoaneurysm. Case 2 A 68-year old man underwent a pancreaticoduo- denectomy because of an invasive cholangiocarcinoma. Transcatheter Management of Hepatic Artery Pseudoaneurysm Following Pancreaticoduodenectomy : a Report of three Cases G. Maleux*, J. Vaninbroukx*, R. Aerts**, B. Topal**, C. Verslype***, D. Vanbeckevoort*, G. Wilms* Departments of Radiology*, Abdominal Surgery** and Hepatology***, University Hospitals, Leuven, Belgium. Key words. Pancreaticoduodenectomy ; surgery, complications ; embolization ; aneurysm (pseudoaneurysm) ; haemor- rhage, gastrointestinal. Abstract. Pseudoaneurysm formation is a rare, but potentially life threatening delayed complication of major pancreatic surgery. Redo surgery several weeks after pancreaticoduodenectomy can be hazardous, especially in debilitated patients. Percutaneous, transcatheter exclusion of the pseudoaneurysm by means of embolic coils can be an efficient, safe and minimally invasive alternative to open surgery with good mid- and long-term results. We present our experience in Three patients undergoing transcatheter embolization of hepatic artery pseudoaneurysms detected several weeks after Whipple’s operation. Fig. 1 Abdominal CT-scan reveals a large, peripherally thrombosed pseudoaneurysm (white arrowheads) located anterior to the aorta and inferior caval vein and dorsal to the splenic vein.