Delayed post-pancreatectomy hemorrhage and bleeding recurrence after percutaneous endovascular treatment: risk factors from a bi-centric study of 307 consecutive patients

Farvacque, Georges; Guilbaud, Théophile; Loundou, Anderson; Scemamma, Ugo; Berdah, Stéphane; Moutardier, Vincent; Chirica, Mircea; Risse, Olivier; Girard, Édouard; Birnbaum, David

doi:10.1007/s00423-021-02146-4

Cited by 16 publications

(24 citation statements)

References 35 publications

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“…Although the need for red blood cell transfusion (42.1%) and admittance to the intensive care unit (31.5%) were observed at relatively higher rates in our study, arterial rebleeding was not observed in any of the cases, and this result was superior to 50.0% of previous reports. The hospitalization period was comparable with previous reports (Hwang et al 2020 ; Farvacque et al 2021 ).…”

Section: Discussionsupporting

confidence: 91%

Efficacy and safety of endovascular therapy for delayed hepatic artery post-pancreatectomy hemorrhage: development of extrahepatic collateral circulation and complications of post endovascular therapy

Nozawa

Ymazoe²,

Masuda

et al. 2022

CVIR Endovasc

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Background Endovascular therapy (ET) for delayed hepatic artery post-pancreatectomy hemorrhage (HA-PPH) may require complete hepatic artery occlusion (HAO). Nonetheless, the development of extrahepatic collateral circulation (EHC) and the relationship between radiological factors (EHC, portal vein stenosis, and HAO) and adverse hepatic events after ET remain unclear. This study aimed to evaluate the efficacy and safety of ET for delayed PPH and examine the development of EHC. Methods A total of 19 ET cases for delayed HA-PPH were reviewed. Hepatic adverse events, portal vein stenosis, HAO, and mortality rate after ET were evaluated. Moreover, EHC from the left gastric artery (LGA), right inferior phrenic artery (RIPA), left inferior phrenic artery (LIPA), right internal thoracic artery (RITA), left internal thoracic artery (LITA), renal artery (RA), omental artery (OA), intercostal artery (IA), and branch of superior mesenteric artery (BSMA) was assessed using angiogram and computed tomography angiography (CTA). Results All cases were successfully treated using transcatheter arterial embolization (n = 17) and stent-graft placement (n = 2) without mortality. EHC from the LGA (8/19), RIPA (10/19), LIPA (4/19), and RITA (3/19) was observed on post-ET CTA. The incidence of hepatic adverse events was significant in the group with both HAO and portal vein stenosis (p < 0.001) and absence of EHC from LIPA and RITA (p < 0.05). Conclusion ET for delayed HA-PPH might be effective and safe. While avoiding both HAO and portal vein stenosis is important, the development of EHCs from LIPA and RITA may prevent hepatic adverse events after ET.

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Section: Discussionsupporting

confidence: 91%

Efficacy and safety of endovascular therapy for delayed hepatic artery post-pancreatectomy hemorrhage: development of extrahepatic collateral circulation and complications of post endovascular therapy

Nozawa

Ymazoe²,

Masuda

et al. 2022

CVIR Endovasc

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“…Importantly, 64% (n = 18) of the patients with abdominal abscess presented a genuine picture of postoperative sepsis. After PD, abdominal abscess favors vessel erosion, leading to severe complications (9), and should be considered as a poorly drained POPF (22). However, in most of the cases, the occurrence of postoperative sepsis was not related to abdominal abscess, and in 35% of the cases, postoperative sepsis evolved into septic shock.…”

Section: Discussionmentioning

confidence: 99%

Late Postpancreaticoduodenectomy Hemorrhage: Incidence, Risk Factors, Management and Outcome

Jacquemin

Mokart

Ewald

et al. 2022

Shock

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Background:Postpancreaticoduodenectomy (PD) hemorrhage (PPH) is a life-threatening complication after PD. The main objective of this study was to evaluate incidence and factors associated with late PPH as well as the management strategy and outcomes. Methods: Between May 2017 and March 2020, clinical data from 192 patients undergoing PD were collected prospectively in the CHIRPAN Database (NCT02871336) and retrospectively analyzed. In our institution, all patients scheduled for a PD are routinely admitted for monitoring and management in intensive/intermediate care unit (ICU/IMC). Results: The incidence of late PPH was 17% (32 of 192), whereas the 90-day mortality rate of late PPH was 19% (6 of 32). Late PPH was associated with 90-day mortality (P = 0.001). Using multivariate analysis, independent risk factors for late PPH were postoperative sepsis (P = 0.036), and on day 3, creatinine (P = 0.025), drain fluid amylase concentration (P = 0.023), lipase concentration (P < 0.001), and C-reactive protein (CRP) concentration (P < 0.001). We developed two predictive scores for PPH occurrence, the PANCRHEMO scores. Score 1 was associated with 68.8% sensitivity, 85.6% specificity, 48.8% predictive positive value, 93.2% negative predictive value, and an area under the receiver operating characteristic curves of 0.841. Score 2 was associated with 81.2% sensitivity, 76.9% specificity, 41.3% predictive positive value, 95.3% negative predictive value, and an area under the receiver operating characteristic curve of 0.859. Conclusions: Routine ICU/IMC monitoring might contribute to a better management of these complications. Some predicting factors such as postoperative sepsis and biological markers on day 3 should help physicians to determine patients requiring a prolonged ICU/IMC monitoring.

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“…Pancreatic fistula, subsequent abdominal abscess, and subsequent pseudoaneurysm, are important inducements for late hemorrhage. 4 , 5 Although there are various possible bleeding sites after PD, the gastroduodenal artery stump is the most common bleeding artery. In our case, although the amylase concentration was elevated temporarily, it did not cause a serious abdominal infection.…”

Section: Discussionmentioning

confidence: 99%

Confusing delayed hematemesis, unusual arterial hemorrhage after pancreaticoduodenectomy: a case report

Wang

Guo

et al. 2022

J Int Med Res

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Pancreaticoduodenectomy (PD) is one of the most complex surgeries and is associated with a high rate of complications, including bleeding, delayed gastric emptying (DGE), and pancreatic fistula. Although the frequency of postoperative hemorrhage is not high, this complication results in severe adverse outcomes. A 67-year-old man was diagnosed with pancreatic cancer and underwent PD. On the tenth day after surgery, he developed hypovolemic shock with hematemesis. Urgent digital subtraction angiography identified the bleeding artery as the jejunal mesenteric artery at the afferent loop, and the bleeding artery was embolized with two coils. After digital subtraction angiography, the patient had an uneventful recovery with no further complications. Therefore, we concluded that it is possible that bleeding may occur in the afferent loop when hemorrhage occurs after PD.

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Delayed post-pancreatectomy hemorrhage and bleeding recurrence after percutaneous endovascular treatment: risk factors from a bi-centric study of 307 consecutive patients

Cited by 16 publications

References 35 publications

Efficacy and safety of endovascular therapy for delayed hepatic artery post-pancreatectomy hemorrhage: development of extrahepatic collateral circulation and complications of post endovascular therapy

Efficacy and safety of endovascular therapy for delayed hepatic artery post-pancreatectomy hemorrhage: development of extrahepatic collateral circulation and complications of post endovascular therapy

Late Postpancreaticoduodenectomy Hemorrhage: Incidence, Risk Factors, Management and Outcome

Confusing delayed hematemesis, unusual arterial hemorrhage after pancreaticoduodenectomy: a case report

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