2007 Abstracts: Pancreatitis As A Complication of Catheter-Based Thrombectomy

Background: Pancreatitis is a complication of intravascular hemolytic disease states. Catheter-based thrombectomy results in mechanical and lytic degradation of thrombin with other blood constituents and can be a life-saving procedure performed with low morbidity. The purpose of this study is to determine the frequency of pancreatitis as a complication of catheter-based thrombectomy in a large treatment series and identify factors that may increase the likelihood of developing pancreatitis.
Methods: We reviewed ICD-9 codes for percutaneous thrombectomies performed by vascular surgeons at our institution between 05/01/2004 and 01/31/2006. Those patients developing abdominal pain with serologic and radiographic signs of acute pancreatitis within 48hrs of thrombectomy were captured by review. Of these, procedural details, co-morbities, medications, and laboratory data were analyzed.
Results: A total of 470 patients underwent catheter-based thrombectomy (AngioJet® thrombectomy system, Possis® Medical) by five vascular surgeons during the study period. Four cases (4/470 = 0.85%) of acute pancreatitis were identified. The mean age was 47 ±14 years with all four patients of male sex. Two of the cases involved percutaneous thrombectomy of iliac arteries, one subclavian vein and one AV graft. During each treatment event 250,000 U of urokinase was administered within the pulsed solution. Two of the patients were dialysis dependent and one had chronic renal insufficiency (creatinine of 1.6). The fourth patient had normal renal function. No patient had a history of pancreatitis and only the patient with normal renal function had a history of alcohol abuse. Each patient experienced symptoms consistent with pancreatitis within 24hrs. The mean amylase and lipase levels were 1649 u/l and 1584 u/l respectively. Computerized tomography (CT) was diagnostic for acute pancreatitis in 3 of 4 cases. In the fourth patient CT imaging was non-diagnostic. This patient underwent exploratory laporatomy where pancreatic inflammation and saponification were identified. Third party diagnosis conformation was obtained for all patients.
Conclusions: Percutaneous thrombectomy resulted in clinically significant acute pancreatitis in 0.85% of patients in our large series. As a previous study suggested, chronic renal insufficiency appeared to be an independent risk factor for the development of pancreatitis. Another common factor in our series appears to relate to thrombectomy of larger diameter vessels, with extensive thrombus degradation. Controlling the runoff during catheter-based thrombectomy may limit systemic circulation of lytic products that can induce pancreatic autolysis.