Stentgraft Implantation for the Treatment of Postoperative Hepatic Artery Pseudoaneurysm

Pedersoli, Federico; Isfort, Peter; Keil, Sebastian; Goerg, F; Zimmermann, Markus; Liebl, Martin; Schulze-Hagen, Maximilian; Schmeding, Maximilian; Kuhl, Christiane K.; Bruners, Philipp

doi:10.1007/s00270-015-1274-1

Cited by 35 publications

(27 citation statements)

References 20 publications

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“…Hepatic artery sacrifice may cause severe hepatic complications due to hepatic flow occlusion. Stentgraft implantation has been revealed to be feasible and effective for treating visceral aneurysms and pseudoaneurysms while preserving vascular patency (Gwon et al 2011;Pedersoli et al 2016;Venturini et al 2017;Schaarschmidt et al 2018;Venturini et al 2018). For delayed PPH, earlier case series have shown the effectiveness of covered stents for hemostasis (Hankins et al 2009;Lovecek et al 2014).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and hepatic complications of three endovascular treatment approaches for delayed postpancreatectomy hemorrhage: evolution over 15 years

et al. 2019

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Background: Delayed postpancreatectomy hemorrhage (PPH) is a fatal complication caused by arterial erosion. This study reports a single-center experience of managing delayed PPH with different endovascular treatment approaches.Methods: We reviewed the data of patients who had delayed PPH due to hepatic artery or gastroduodenal artery stump perforation and underwent endovascular treatment between 2003 and 2018. We categorized endovascular treatment approaches involving hepatic artery sacrifice, superselective pseudoaneurysm embolization with hepatic artery preservation, and covered stent placement. Technical success rates, hemorrhage recurrence rates, major and minor hepatic complication rates, and 30-day and 1-year mortality rates were assessed.Results: A total of 18 patients were reviewed; 11 (61%), 4 (22%), and 3 (17%) delayed PPH cases were managed through hepatic artery sacrifice, superselective pseudoaneurysm embolization, and hepatic artery stenting, respectively. Multidetector computed tomography was performed in 14 (78%) patients. The technical success rate was 100%. The overall hemorrhage recurrence rate was 39%, with superselective pseudoaneurysm embolization having a 100% hemorrhage recurrence rate-much higher than that of hepatic artery sacrifice or stent graft placement. The overall major and minor hepatic complication rates were 56% and 83%, respectively. The overall 30day and 1-year mortality rates were 11% and 25%, respectively. The 30-day and 1-year mortality rates and minor and major hepatic complication rates were similar in each group. Conclusion: Hepatic artery sacrifice is more effective than superselective pseudoaneurysm embolization in the management of delayed PPH. Covered stent placement may be a reasonable alternative treatment to hepatic artery sacrifice.

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Section: Discussionmentioning

confidence: 99%

Efficacy and hepatic complications of three endovascular treatment approaches for delayed postpancreatectomy hemorrhage: evolution over 15 years

et al. 2019

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“…In an emergency setting, when time becomes crucial, stent-graft placement can lead to immediate exclusion of the target PSA with a relatively short operative time (28). Moreover, stent graft implantation has been associated with a lower use of fluoroscopy during the procedure (58). The most common complications of stent graft implantations are endoleaks and stent thromboses (58,79), but stent dislocation and consequent rebleedings have also been described (80).…”

Section: Stent-graftsmentioning

confidence: 99%

“…Moreover, stent graft implantation has been associated with a lower use of fluoroscopy during the procedure (58). The most common complications of stent graft implantations are endoleaks and stent thromboses (58,79), but stent dislocation and consequent rebleedings have also been described (80). Another potential severe complication is infection of the stent when contact with gastrointestinal content or infected necrotic tissue occurs (58).…”

Section: Stent-graftsmentioning

confidence: 99%

Bleeding complications after pancreatic surgery: interventional radiology management

2019

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Surgical intervention in the pancreas region is complex and carries the risk of complications, also of vascular nature. Bleeding after pancreatic surgery is rare but characterized by high mortality. This review reports epidemiology, classification, diagnosis and treatment strategies of hemorrhage occurring after pancreatic surgery, focusing on the techniques, roles and outcomes of interventional radiology (IR) in this setting. We then describe the roles and techniques of IR in the treatment of other less common types of vascular complications after pancreatic surgery, such as portal vein (PV) stenosis, portal hypertension and bleeding of varices.

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“…The common locations of HAPs are common hepatic artery (63%), and right hepatic artery (28%) [2]. Extrahepatic artery is more frequently affected by HAP after major pancreaticoduodenal surgery [10]. In our study, HAP in all two patients with history of Whipple's operation was limited at proper hepatic artery, whereas HAP in the other patients without pancreaticoduodenal operation was located at diverse segments of hepatic artery.…”

Section: Discussionmentioning

confidence: 68%

“…Because of rarity of HAP, most published reports were case reports and few original articles with small numbers of patients [5] [9] [10]. In this study, we comprehensively reviewed diverse clinical presentation by various kinds of factors and proposal of minimally invasive endovascular management with consideration of clinical success and complication about HAP including our cases.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Endovascular Coil Embolization of Ruptured Hepatic Artery Pseudoaneurysm

Seo¹

2017

ACT

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Purpose: To assess the efficacy of endovascular management for ruptured hepatic artery pseudoaneurysm (HAP). Methods: Six cases of HAP in five patients (four men and one women; mean age, 50; range, 28 -62) were treated with transcatheter arterial coil embolization using microcoil (Boston Scientific, Watertown, MA, USA) and Tornado Coil (Cook, Bloomington, IN, USA) with or without stent graft between January 2007 and September 2008. They were analyzed with regard to the clinical presentation, radiological findings with procedure, and clinical and radiologic outcomes. Results: All patients presented with epigastric pain or gastrointestinal bleeding. The pseudoaneurysms were ranged from 0.6 to 4.4 cm in size and located in the common hepatic artery (n = 1), junction between proper and right hepatic artery (n = 1), proper hepatic artery (n = 2), the left hepatic artery (n = 1), right hepatic artery (n = 1). Embolization was performed with microcoils in all pseudoaneurysmal sac with or without both afferent and efferent segment. A self-expandable stent (n = 1) was also used. Overall technical success was 100% (6 of 6) and complete occlusions of HAPs were achieved in 5 out of 6 cases, 83.3% of clinical success rate. Re-bleeding occurred in one case of stent graft at proper hepatic artery following coil packing for pseudoaneurysmal sac. Clinical success rate of embolization for both afferent and efferent segment was 100% (3 of 3). Procedure-related minor complications happened in 2 of 5 patients, and they were treated conservatively. Conclusion: Transcatheter coil embolization for ruptured HAP is sufficiently effective and additional embolization in both afferent segment and efferent segment can improve clinical success rate.

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Stentgraft Implantation for the Treatment of Postoperative Hepatic Artery Pseudoaneurysm

Abstract: Stentgraft implantation is a safe and effective technique to treat hepatic artery pseudoaneurysms related to major pancreatic or hepatic surgery, especially in the setting of acute hemorrhage.

Cited by 35 publications

References 20 publications

Efficacy and hepatic complications of three endovascular treatment approaches for delayed postpancreatectomy hemorrhage: evolution over 15 years

Efficacy and hepatic complications of three endovascular treatment approaches for delayed postpancreatectomy hemorrhage: evolution over 15 years

Bleeding complications after pancreatic surgery: interventional radiology management

Effectiveness of Endovascular Coil Embolization of Ruptured Hepatic Artery Pseudoaneurysm

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