Maatman, Thomas K.Heimberger, Mark A.Lewellen, Kyle A.Roch, Alexandra M.Colgate, Cameron L.House, Michael G.Nakee, AttilaCeppa, Eugene P.Schmidt, C. MaxZyromski, Nicholas J.2022-05-032022-05-032020-05-21Maatman TK, Heimberger MA, Lewellen KA, et al. Visceral artery pseudoaneurysm in necrotizing pancreatitis: incidence and outcomes. Can J Surg. 2020;63(3):E272-E277. Published 2020 May 21. doi:10.1503/cjs.009519https://hdl.handle.net/1805/28821Background: Visceral artery pseudoaneurysms (VA-PSA) occur in necrotizing pancreatitis; however, little is known about their natural history. This study sought to evaluate the incidence and outcomes of VA-PSA in a large cohort of patients with necrotizing pancreatitis. Methods: Data for patients with necrotizing pancreatitis who were treated between 2005 and 2017 at Indiana University Health University Hospital and who developed a VA-PSA were reviewed to assess incidence, presentation, treatment and outcomes. Results: Twenty-eight of 647 patients with necrotizing pancreatitis (4.3%) developed a VA-PSA between 2005 and 2017. The artery most commonly involved was the splenic artery (36%), followed by the gastroduodenal artery (24%). The most common presenting symptom was bloody drain output (32%), followed by incidental computed tomographic findings (21%). The median time from onset of necrotizing pancreatitis to diagnosis of a VA-PSA was 63.5 days (range 1-957 d). Twenty-five of the 28 patients who developed VA-PSA (89%) were successfully treated with percutaneous angioembolization. Three patients (11%) required surgery: 1 patient rebled following embolization and required operative management, and 2 underwent upfront operative management. The mortality rate attributable to hemorrhage from a VA-PSA in the setting of necrotizing pancreatitis was 14% (4 of 28 patients). Conclusion: In this study, VA-PSA occurred in 4.3% of patients with necrotizing pancreatitis. Percutaneous angioembolization effectively treated most cases; however, mortality from VA-PSA was high (14%). A high degree of clinical suspicion remains critical for early diagnosis of this potentially fatal problem.en-USAttribution-NonCommercial-NoDerivatives 4.0 InternationalFalse aneurysmTherapeutic embolizationAcute necrotizing pancreatitisArticle