Endovascular Treatment of Pancreatitis-Associated Visceral Artery Pseudoaneurysms: Effectiveness, Volume Regression and Impact on Mass Effect

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Abstract Objective Visceral artery pseudoaneurysms (VAPAs) are a life-threatening complication of pancreatitis. This study aimed to evaluate the early outcomes of endovascular treatment (EVT), its effect on the reduction of VAPA sac volume, and the resolution of extrinsic compression (mass effect) caused by VAPAs within three months after the procedure. Patients and Methods We retrospectively analysed 20 patients who underwent endovascular treatment for pancreatitis-associated VAPAs between August 2006 and September 2025. Depending on the anatomical setting, various EVT techniques were used, including coil embolisation, application of n-butyl-2-cyanoacrylate tissue adhesive, and covered stent implantation. We assessed EVT success and related complications. In a subgroup of 11 patients, we evaluated changes in VAPA sac volume before and after endovascular therapy. In patients with VAPA-related mass effect, we analysed the post-EVT course of the clinical manifestations of extrinsic compression. Results Primary technical success was achieved in all 20 patients (100%); in one patient repeated embolisation was required (5%). One patient developed a large splenic infarction requiring splenectomy. Median regression of VAPA sac volume reached 69.4% within 1 month after EVT and 96.5% within 3 months ( P < 0.0001). Symptomatic mass effect was observed in three patients, and clinical symptoms improved in all of them after EVT. Conclusions Endovascular treatment is an effective therapeutic modality for pancreatitis-associated VAPA and leads to a significant reduction in pseudoaneurysm sac volume. In patients with symptomatic mass effect, EVT may also be associated with regression of clinical symptoms.

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