Transcatheter Arterial Embolization for Postoperative Bleeding Following Abdominal Surgery

Chatani, Shohei; Inoue, Akitoshi; Ohta, Shin‐ichi; Takaki, Kai; Sato, Shigeo; Iwai, Takayasu; Murakami, Yoko; Watanabe, Shobu; Sonoda, Akinaga; Nitta, Norihisa; Maehira, Hiromitsu; Tani, Masaji; Murata, Kiyoshi

doi:10.1007/s00270-018-2019-8

Cited by 21 publications

(19 citation statements)

References 24 publications

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“…In this study, we found that postoperative abdominal bleeding remained as an independent risk factor of 60-day all-cause mortality in the multivariable analysis. Postoperative hemorrhage following abdominal tumor surgery was a potentially fatal complication, and was associated with high mortality rate of up to 54% (26). Our study showed that 7 patients in non-survivors group presented postoperative abdominal bleeding, with the mortality rates up to 87.5%.…”

Section: Discussionmentioning

confidence: 52%

“…Therefore, for abdominal tumor patients suffering postoperative abdominal bleeding, the empiric use of broad-spectrum antibiotics should be considered as soon as possible to control suspected or documented abdominal infection. On the other hand, transcatheter arterial embolization (TAE) should be considered as the choice of management when possible in addition to timely and early surgical interventions (26).…”

Section: Discussionmentioning

confidence: 99%

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A randomized controlled trial comparing the efficacy of tigecycline versus meropenem in the treatment of postoperative complicated intra-abdominal infections

Wang

Xing

et al. 2021

Ann Palliat Med

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Background: The efficacy and safety of tigecycline in the treatment of complicated intra-abdominal infections (cIAIs) is potentially controversial. Here we conducted the non-inferiority study to assess the efficacy and safety of tigecycline versus meropenem in the treatment of postoperative cIAIs.Methods: Data of abdominal tumor surgery patients with postoperative cIAIs admitted to intensive care unit (ICU) between October 2017 and December 2019 were collected. A prospective, randomized controlled trial was conducted in which 56 eligible patients with cIAIs randomly received intravenous tigecycline or meropenem for 3 to 14 days. Patients and clinicians were not blinded to the group allocation.Results: The total of 56 patients were enrolled, which were divided into 2 groups, one group included 30 patients receiving meropenem and another group included 26 receiving tigecycline therapy. The 2 groups were similar at demographic and baseline clinical characteristics. Microorganisms were isolated from 46 of 56 patients (82.14%), with a total of 107 pathogens were cultured in two groups. The two groups had similar distribution of infecting microorganisms. The primary end point was the clinical response at the end-oftherapy (EOT) visit and upon discharge visit and comprehensive efficacy. The clinical success rates were 83.33%, 76.67% for meropenem versus 76.92%, 88.46% for tigecycline at the EOT visit and upon discharge visit (P>0.05), respectively. Comprehensive efficacy did not significantly differ between two groups either. There were no significant differences in 30-day and 60-day all-cause mortality between two groups (P>0.05).The univariable analysis identified that serum albumin at admission ICU, colorectal cancer on oncology type, postoperative abdominal bleeding were the risk factors for 60-day all-cause mortality. The multivariable analysis showed that postoperative abdominal bleeding were independent predictors of 60-day all-cause mortality. Gastrointestinal disorders and antibacterials-induced Fungal Infection were the most frequently reported adverse events (AEs). The incidence of AEs was similar between meropenem and tigecycline groups (P>0.05). Conclusions:Taken together, the study demonstrated that tigecycline is as effective and safe as meropenem for postoperative cIAIs in abdominal tumors patients. Tigecycline is non-inferior to meropenem.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

A randomized controlled trial comparing the efficacy of tigecycline versus meropenem in the treatment of postoperative complicated intra-abdominal infections

Wang

Xing

et al. 2021

Ann Palliat Med

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“…MDCT has been described as an essential tool for detecting bleeding in delayed PPH and other postoperative bleeding conditions (Chatani et al 2018;Biondetti et al 2019). According to our experience, MDCT may be helpful as a tailored treatment strategy for individual patients.…”

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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“…However, in our case, a re-thoracotomy to control bleeding can be di cult and tedious, owing to severe infection, the anatomic inaccessibility caused by extensive adhesion and limited exposure of the thoracic roof. On the contrary, TAE is minimally invasive, facilitates the identi cation of bleeding sources (extravasation or irregular arterial walls) through angiography, and can effectively achieve hemostasis [5]. Moore C et al had extended this technique to the thoracic cavity by using selective thoracic aortography with transcatheter embolization of intercostal artery, providing a minimally invasive auxiliary method for the treatment of refractory intrathoracic hemorrhage [6].…”

Section: Discussionmentioning

confidence: 99%

“…Microcoils, polyvinyl alcohol particles, NBCA, vascular plugs, and gelatin sponges are used as embolic agents. Interventional radiologists should fully consider the unique characteristics and embolization mechanism of each embolic agent, and select the appropriate embolic agent based on collateral network, vascular lesions, cost and operator skills [5].…”

Section: Discussionmentioning

confidence: 99%

Transcatheter arterial embolization for delayed recurrent intrathoracic bleeding caused by anastomotic leakage after minimally invasive McKeown esophagectomy

Zhou

2021

Preprint

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Background: Anastomotic leakage (AL) is a serious complication after minimally invasive esophagectomy (MIE). Its development into delayed recurrent intrathoracic bleeding is very rare and may lead to fatal consequences.Case presentation: We report a case of 67-year-old female who developed intrapleural infection, mediastinal infection and delayed recurrent intrathoracic bleeding as a complication of AL following minimally invasive McKeown esophagectomy. The triple antibiotics of imipenem and cilastatin sodium, vancomycin, and fluconazole were used for anti-infection treatment. Transcatheter embolization of subclavian artery branch vessel avoided re-bleeding. As a result, the patient recovered well and was discharged 58 days after initial surgery.Conclusion: Delayed recurrent intrathoracic bleeding owing to AL is a rare and life-threatening complication after MIE. Transcatheter arterial embolization (TAE) can provide a minimally invasive and effective method to control delayed recurrent intrathoracic bleeding after esophagectomy.

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Transcatheter Arterial Embolization for Postoperative Bleeding Following Abdominal Surgery

Abstract: TAE is a safe and effective for treating postoperative hemorrhage even in patients with hemodynamic instability and pancreatic fistula. Additionally, pre-interventional CT is useful for effective, consecutive interventions.

Cited by 21 publications

References 24 publications

A randomized controlled trial comparing the efficacy of tigecycline versus meropenem in the treatment of postoperative complicated intra-abdominal infections

A randomized controlled trial comparing the efficacy of tigecycline versus meropenem in the treatment of postoperative complicated intra-abdominal infections

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

Transcatheter arterial embolization for delayed recurrent intrathoracic bleeding caused by anastomotic leakage after minimally invasive McKeown esophagectomy

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