Outcomes of Arterial Embolization vs Covered Stents for Delayed Massive Hemorrhage After Pancreatic or Biliary Surgery

Watanabe, Yukihiro; Nakazawa, Kimitaka; Takase, Kenichiro; Watanabe, Yuichiro; Okada, Katsuya; Aikawa, Masayasu; Okamoto, Koichi; Koyama, Isamu

doi:10.1007/s11605-022-05259-3

Cited by 3 publications

(1 citation statement)

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“…The process is tortuous, and the patient being in a severe or very critical condition makes stenting unsuitable. Previous case reports and studies have shown good results in terms of stent placement [ 10 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. Therefore, we recommend stenting if the patient has underlying liver disease ( Figure 7 ).…”

Section: Discussionmentioning

confidence: 99%

Comparing the Clinical Efficacy of Coil Embolization in GDA Stump versus Common Hepatic Artery in Postoperative Hemorrhage after Pancreatoduodenectomy

Chen

Lee

et al. 2023

JPM

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Background: Hemorrhage after pancreaticoduodenectomy is an uncommon but fatal complication. In this retrospective study, the different treatment modalities and outcomes for treating post-pancreaticoduodenectomy hemorrhage are analyzed. Methods: Our hospital imaging database was queried to identify patients who had undergone pancreaticoduodenectomy during the period of 2004–2022. The patients were retrospectively split into three groups, according to their treatment: conservative treatment without embolization (group A: A1, negative angiography; A2, positive angiography), hepatic artery sacrifice/embolization (group B: B1, complete; B2, incomplete), and gastroduodenal artery (GDA) stump embolization (group C). Results: There were 28 patients who received angiography or transarterial embolization (TAE) treatment 41 times (cases). In group A, high re-bleeding rates (54.5%, 6/11 cases) were observed, with 44.4% (4/9 cases) for subgroup A1 and 100% (2/2 cases) for subgroup A2. In group B, the re-bleeding rates were lowest (20%, 4/20 cases) with 0% (0/16 cases) for subgroup B1 and 100% (4/4 cases) for subgroup B2. The rate of post-TAE complications (such as hepatic failure, infarct, and/or abscess) in group B was not low (35.3%, 6/17 patients), especially in patients with underlying liver disease, such as liver cirrhosis and post-hepatectomy (100% (3/3 patients), vs. 21.4% (3/14 patients); p = 0.0294, p < 0.05). The highest rate of re-bleeding (55.6%, 5/9 cases) was observed for group C. There was a significant difference in the re-bleeding rates of subgroup B1 and group C (p = 0.002). The more iterations of angiography, the higher the mortality rate (16.7% (2/12 patients), <3 times vs. 60% (3/5 patients), ≥3 times; p = 0.1165). Conclusions: The complete sacrifice of the hepatic artery is an effective first-line treatment for pseudoaneurysm or for the rupture of the GDA stump after pancreaticoduodenectomy. Hepatic complications are not uncommon and are highly associated with underlying liver disease. Conservative treatment, the selective embolization of the GDA stump, and incomplete hepatic artery embolization do not provide enduring treatment effects.

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