Pancreaticoduodenal arcades as salvage route for transarterial embolization of life-threatening hepatic hemorrhage in patients with severe celiac axis stenosis: Case series

Abstract

HighlightsHepatic hemorrhage is a life-threatening situation in which a rapid access to hepatic arteries is vital to achieve transarterial hemostasis.The celiac axis should be considered first to gain access to hepatic arteries in such situations.Pancreaticoduodenal arcade is a salvage alternative route for emergency transarterial embolization in case of massive liver hemorrhage in patient with celiac axis extensive stenosis or occlusion.

Management for traumatic hepatic injury diagnosed by contrast-enhanced ultrasonography in a patient with an occluded coeliac axis: a case report

“…11,12 Specifically, the relevant CT findings are: dilatation of the peripancreatic collateral vasculature, effacement or narrowing of the coeliac axis by an anterior soft tissue band, and poststenotic dilatation of the distal portion of the coeliac axis. 4,11 In this current case, initial CT images revealed the MAL of the diaphragm to be obstructing the coeliac axis. Therefore, cannulation of the stenotic coeliac axis was attempted, and subsequently, the catheter was successfully advanced via the occluded coeliac axis.…”

“… 3 , 7 However, endovascular treatment for haemorrhages following traumatic hepatic injury is sometimes technically challenging, and occasionally even impossible, due to an unfavourable vascular anatomy, such as that caused by CAS, resulting in a difficult approach to the injured vessels. 4 , 5 , 10 To safely and successfully insert the catheter into the bleeding site through the occluded coeliac axis, it is important to understand the pathological cause and anatomical structure of the occluded site, and adjust the catheterization technique accordingly. 7 …”

“…These collateral routes can be a secondary route choice for hepatic embolization in patients with CAS. 4 , 5 However, according to previously published reports, when performing microcatheter manipulation and superselective catheterization of feeding arteries, an approach through the occluded coeliac axis is better than an approach through collateral pathways such as the pancreaticoduodenal arcades. 6 , 10 In this current case, a long and overly tortuous unique collateral pathway made it difficult to control the tip of the microcatheter, lengthening the procedure time and eventually resulting in failure to advance the catheter to the bleeding site.…”

“… 2 , 3 However, it is sometimes technically challenging to perform when endovascular treatment is not feasible due to limitations, such as those caused by anatomical anomalies of blood vessels. 4 , 5 Among such anomalies, coeliac axis stenosis (CAS) is a limiting factor with respect to accessibility of the damaged hepatic vessels. 5 , 6 For TAE to be performed successfully, selective catheterization of bleeding branches is necessary.…”

“…There is limited research considering the efficacy and safety of TAE for traumatic hepatic injury in patients with CAS. 4 , 6 In addition, although contrast-enhanced ultrasonography (CEUS) is considered a useful tool in the differential diagnosis of hepatic nodules, its modality for identifying active bleeding in hepatic injury is little-explored. 8 , 9 This current case report describes haemorrhage following blunt hepatic injury, confirmed by CEUS, in a patient with unique collateral pathways caused by a combination of CAS and an aberrant hepatic artery.…”