CASE REPORT Combined percutaneous thrombin injection and endovascular treatment of gastroduodenal artery pseudoaneurysm (PAGD): case report Gianpaolo Carrafiello & Domenico Laganà & Chiara Recaldini & Monica Mangini & Domenico Lumia & Andrea Giorgianni & Anna Leonardi & Carlo Fugazzola Received: 17 October 2006 / Accepted: 28 December 2006 / Published online: 31 January 2007 # Am Soc Emergency Radiol 2007 Abstract A 69-year-old man with a history of acute pancreatitis developed a huge pseudoaneurysm of the gastroduodenal artery (PAGD), as diagnosed by CT scan. The PAGD was treated by percutaneous thrombin injection (2,000 IU) under ultrasound guidance and selective embo- lization of gastroduodenal artery with microcoils with its complete exclusion. The 6-month follow-up confirmed the complete exclusion of the PAGD sac. Keywords Pseudoaneurysm . Ultrasound guidance . Thrombin injection . Gastroduodenal artery . Endovascular treatment Introduction Pseudoaneurysm may result from either autodigestion of a peripancreatic artery or erosion of a pseudocyst into a visceral artery with disruption of the arterial continuity [1]. The hemorrhage is contained by a fibrous tissue capsule that progressively enlarges owing to unrelenting arterial pressure [1, 2]. Asymptomatic pseudoaneurysm is occasionally reported in the course of an ultrasound (US) or CT examination. Angiography reports the presence of pseudoaneurysm, without bleeding, in 10–21% of patients with chronic pancreatitis [1, 3] and in 10–31% of patients with pseudocyst [1, 4, 5]. Hemorrhagic complications are expected in 7–14% of those suffering from chronic pancreatitis [1, 6] and in 6–31% patients with pancreatic pseudocyst [1, 7]. Rupture of pseudoaneurysm is a relatively rare but life- threatening complication of pancreatitis: The mortality rate ranges from 20 to 43% in untreated patients [8, 9]. Percutaneous techniques have been used with increasing frequency in the management of visceral pseudoaneurysms as an alternative of surgery [10–12]. The objective of the present report is to describe the case of a patient affected by gastroduodenal artery pseudoaneu- rysm (PAGD) treated with a combined percutaneous and endovascular treatment. Case report A 69-year-old man with a history of acute pancreatitis and gallbladder stones was admitted to a hospital for laparo- scopic cholecystectomy. During hospitalization, the patient had an intestinal occlusion on stenosis ground that required a left colon surgery resection, with antero-lateral anasto- mosis on the transverse colon and cholecystectomy. Post surgery time was complicated by the presence of multiple fluid abdominal collections. A percutaneous US-guided drainage in right pararenal cavity was performed position- ing an 8-Fr catheter. Emerg Radiol (2007) 14:51–54 DOI 10.1007/s10140-007-0574-4 G. Carrafiello : D. Laganà : C. Recaldini : M. Mangini : D. Lumia : A. Giorgianni : A. Leonardi : C. Fugazzola Department of Radiology, University of Insubria, Viale Borri, 57, 21100 Varese, Italy D. Lumia e-mail: domenicolumia@gmail.com G. Carrafiello (*) Radiologia Ospedale di Circolo-Fondazione Macchi, Viale Borri, 57, 21100 Varese, Italy e-mail: gcarraf@tin.it