Endovascular embolization of arterial bleeding in patients with severe acute pancreatitis.

Abstract

IntroductionSevere acute pancreatitis (SAP) has a high mortality rate of 20% to 30%, with death often resulting from hemorrhage.AimTo investigate the role of digital subtraction angiography (DSA) and endovascular embolization in the management of arterial bleeding in SAP patients.Material and methodsSeventy-six patients with SAP admitted to our hospital between January 2010 and May 2016 underwent DSA. DSA revealed arterial bleeding in 22 of these patients, who were treated with transcatheter endovascular embolization with coils and/or gelfoam particles. Patient demographics, angiographic features of vascular abnormalities, and outcomes of embolization were assessed.ResultsArterial bleeding was the most common vascular abnormality (22/76 patients; 28.9%). DSA enabled the identification of 27 bleeding arteries in 22 patients. The splenic artery was the most commonly affected vessel (11/27; 40.7%). Among the 27 arteries treated with endovascular embolization, successful hemostasis was achieved in 96.3% (26/27). Two patients developed major complications (hepatic and splenic abscess). These patients were treated with abdominal catheter drainage and anti-infection measures and ultimately recovered. The mean interval between initial onset of SAP and angiographic diagnosis of arterial bleeding was 56 days. Rebleeding was diagnosed in 5 patients (5/22; 22.7%) during repeat angiography, with bleeding from new sites in four of these patients. The mean interval between successive angiography treatments was 38 days.ConclusionsEndovascular embolization is a safe and effective method to localize bleeding arteries and achieve complete hemostasis in patients with SAP-related arterial bleeding.

Giant Hemorrhagic Pancreatic Pseudocyst: A Case Report and Guidelines for Care

“…Finally, regarding thrombotic methods, hemorrhagic pseudocysts are formed when enzymes within pancreatic fluid erode arterial walls, and the most commonly affected artery is the splenic artery (30-50%), followed by gastroduodenal (17%), and pancreaticoduodenal arteries (11%) [ 16 ]. Angiographic embolization has a success rate ranging from 79 to 100% [ 17 ].…”

“…In one study involving 76 patients, three patients died, two from hemorrhagic shock and one from brain stem infarction secondary to coagulation system dysfunction in severe acute pancreatitis [ 17 ].…”

Indian College of Radiology and Imaging Consensus Guidelines on Interventions in Pancreatitis

“…The use of gelfoam alone has been described in a limited number of patients in published series on the endovascular embolization of PSA. 100 101 Kulkarni et al reported gelfoam embolization in one patient in a series of 38 patients. In the same series, gelfoam was used in combination with coils in two patients.…”

InterNet: Detection of Active Abdominal Arterial Bleeding Using Emergency Digital Subtraction Angiography Imaging With Two-Stage Deep Learning

“…Most cases of active abdominal arterial bleeding are medically treated by correcting coagulation abnormalities or through endoscopy (7)(8)(9). Nonetheless, these methods can fail in some patients with significant bleeding, in which cases endovascular treatment is desired (3,(10)(11)(12)(13)(14). Due to its advantages of reduced morbidity and mortality, endovascular treatment using digital subtraction angiography (DSA) is now preferred over open surgery (5,11,(15)(16)(17).…”