Pseudoaneurysm after Pylorus-preserving Pancreatoduodenectomy with Preservation of the Right Gastroepiploic Artery Used for Coronary Artery Bypass Grafting: A Case Report

Abstract

A 73-year-old man presented to our hospital for the treatment of a tumor of the ampulla of Vater. He had previously undergone coronary artery bypass grafting using the right gastroepiploic artery. Accordingly, we performed pylorus-preserving pancreatoduodenectomy (PPPD), preserving the right gastroepiploic artery graft. On postoperative day 28, bleeding caused by the postoperative pancreatic fistula was observed from the pseudoaneurysm at the root of the gastroduodenal artery. Preoperatively, the cardiac bypass area was estimated to be so small such that embolization of the bypass graft would not affect cardiac function. Therefore, transarterial embolization of the bypass graft was performed. Actually, no adverse cardiac events were noted. Therefore, preoperative evaluation of possible embolization of a pseudoaneurysm after PPPD with the preservation of the right gastroepiploic artery used for coronary artery bypass grafting is essential.