E4558. Vascular Complications After Whipple Procedure: Imaging Diagnosis and Endovascular Management
  1. Will Roeder; University of Nebraska Medical Center
  2. Harvey Sekhon; University of Nebraska Medical Center
  3. Gunnar Whealy; University of Nebraska Medical Center
  4. Lei Yu; University of Nebraska Medical Center
Whipple procedure, or pancreaticoduodenectomy, is the most common surgery performed for malignancies of the pancreatic head, periampullary, and ampullary regions. Despite refinements in surgical techniques, Whipple procedure is associated with a relative high rate of postoperative complications. Although rare, vascular complications, including hemorrhage, pseudoaneurysm, and thrombosis, are associated with high mortality. Knowledge of imaging findings and endovascular treatments are critical in the management of those complications.

Educational Goals / Teaching Points
Our educational goals for this exhibit are to grow the learner's proficiency in identifying and managing vascular complications following Whipple procedure. Through case presentation from a large academic center, we will review vascular anatomy, clinical presentation of vascular complications, imaging findings and endovascular management strategies.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Postoperative bleeding can occur acutely following surgery and is usually due to technique failure (i.e., incomplete ligation at gastroduodenal artery stump). More commonly, vascular complications happen days or weeks after the surgery with various clinical presentations. CT plays a crucial role in the diagnosis of vascular complications. Typical findings on CT include active contrast extravasation, pseudoaneurysm, vessel thrombosis, or organ ischemia. Endovascular intervention is a safe and effective alternative to surgery and is often the preferred approach due to its minimally invasive nature. Based on location and size of vessel involved, coil embolization or stent graft are often used. Each of our cases will demonstrate key imaging findings, clinical decision-making, and treatment strategies. Posttreatment clinical courses, management and follow-up will be discussed. Presented cases include hepatic artery thrombosis, gastroduodenal artery pseudoaneurysm, and proper hepatic artery pseudoaneurysm.

Vascular complications after Whipple procedure are rare but life-threating. Prompt identification of different types of vascular complications on imaging studies and appropriate endovascular interventions are key to improve patient’s outcome.