Fr301 VISCERAL ARTERY PSEUDOANEURYSMS (PSA) IN PATIENTS WITH NECROTIZING PANCREATITIS (NP): RISK OF EARLY BLEEDING WITH SHORT TERM LUMEN APPOSING METAL STENTS (LAMS) PLACEMENT

Background and Aim Visceral artery pseudoaneurysm (PSA) in necrotizing pancreatitis (NP) is associated with significant morbidity and mortality. In this study, we aimed to evaluate the incidence, clinical presentation, management and outcomes of PSA in NP. Methods All necrotizing pancreatitis (NP) patients managed at our institution between 2010-2020 were reviewed from a prospectively maintained database for the diagnosis of PSA. Data on risk factors, presentation, diagnosis, management and outcomes were collected. Results Thirty-nine (6.5%) of 604 patients with NP had a confirmed diagnosis of PSA. Age of NP onset, gender, etiology of NP, need for percutaneous, endoscopic drainage, or surgical necrosectomy for walled off necrosis (WON) were similar between PSA vs. no-PSA (Table 1). The median duration of index hospitalization when PSA was diagnosed was 21 days (Interquartile range (IQR): 10-56 d). 28 (71.8 %) patients were admitted to the intensive care unit (ICU) with median ICU stay of 9 days (IQR: 3.3-24 d). In-hospital mortality was observed in 9 (23.1%) patients. The most common clinical presentations of PSA were acute blood loss anemia (77%), gastrointestinal (GI) bleeding (74.3%), hemorrhagic shock (30%), and as an incidental finding on abdominal imaging (10.3%). Methods of PSA diagnosis are shown in (Table 2). Comupterized tomography (CT) imaging was false negative in four patients (CT angiography in three, CT abdomen with contrast in one). Arteries commonly involved were splenic (50%), gastroduodenal (28%) and pancreaticoduodenal arteries (12%). Lumen apposing metal stents (LAMS) for endoscopic drainage of WON were used in 17 patients, and 8 (47.1%) patients had an indwelling LAMS at the time of PSA diagnosis. The median time from LAMS insertion to PSA diagnosis was 15 d (IQR: 8-31.5 d) compared to 69 d (IQR: 40-107 d) in patients who had LAMS removed prior to PSA diagnosis (N=9)(P