Clinical studyTranscatheter Arterial Embolization of Gastroduodenal Artery Stump Pseudoaneurysms after Pancreaticoduodenectomy: Safety and Efficacy of Two Embolization Techniques
Section snippets
Patients
Between March 2003 and March 2008, a total of 192 patients underwent pancreaticoduodenectomy at a single institution. By searching our surgical database, 20 patients were identified who underwent TAE for treatment of delayed massive hemorrhage (> 24 h after the index operation, decrease of hemoglobin level by > 3 g/dL) (3). The site of bleeding included GDA stump (n = 16), gastrojejunal anastomosis (n = 2), and jejunal artery (n = 2). The 16 patients with GDA stump bleeding were included in
Results
All TAE procedures were technically successful and initial hemostasis was achieved in all patients in both groups. In group A, intrahepatic arterial flow through the common hepatic artery was completely interrupted. However, maintenance of hepatic arterial flow was verified on postembolic angiograms in 10 patients (76.9%). The major collateral routes were the right inferior phrenic artery (n = 2; Fig 1), left gastric artery (n = 3; Fig 2), and both (n = 1). In four patients with hepatic
Discussion
There has been a continued debate in the literature regarding the optimal management of delayed massive hemorrhage after pancreaticoduodenectomy (5, 6, 7). Immediate angiography to identify the site of bleeding with subsequent treatment by radiologic intervention has been the first approach for the past decade (11, 16, 17). However, several recent investigations insisted that surgery should be a primary treatment in massive bleeding and the application of TAE should be limited to patients in
References (22)
Evidence-based management of hemorrhage after pancreaticoduodenectomy
Am J Surg
(2007)- et al.
Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition
Surgery
(2007) - et al.
Hemorrhage after pancreaticoduodenectomy: when is surgery still indicated?
Am J Surg
(2007) - et al.
Superselective microcoil embolization: treatment of choice in high-risk patients with extrahepatic pseudoaneurysms of the hepatic arteries
J Am Coll Surg
(1998) - et al.
Management of massive arterial hemorrhage after pancreatobiliary surgery: does embolotherapy contribute to successful outcome?
J Gastrointest Surg
(2007) - et al.
Results of non-operative therapy for delayed hemorrhage after pancreaticoduodenectomy
J Gastrointest Surg
(2009) - et al.
Stent-assisted coil embolization of wide-necked renal artery bifurcation aneurysms
J Vasc Interv Radiol
(2008) - et al.
Society of Interventional Radiology clinical practice guidelines
J Vasc Interv Radiol
(2003) - et al.
Endovascular management of hepatic artery pseudoaneurysm hemorrhage complicating pancreaticoduodenectomy
J Vasc Surg
(2006) - et al.
Use of a stent graft for bleeding hepatic artery pseudoaneurysm following pancreaticoduodenectomy
Asian J Surg
(2006)
Postoperative hemorrhage after major pancreatobiliary surgery: an update
Hepatogastroenterology
Cited by (59)
Cross-sectional imaging after pancreatic surgery: The dialogue between the radiologist and the surgeon
2024, European Journal of Radiology OpenStent-graft placement for hepatic arterial bleeding: assessment of technical efficacy and clinical outcome in a tertiary care center
2022, HPBCitation Excerpt :Operative management of the hepatic artery injury is associated with a high mortality rate, and bleeding sites may not be reached due to dense adhesions, inflammation, and massive bleeding.12,13 Although coil embolization of the aneurysm sac and preserving the parent artery is an option in cases with pseudoaneurysm, the rebleeding rate has been reported up to 100%.14 Embolization of the hepatic artery with coils has been used to control bleeding with high technical success, but despite the liver's second blood supply via the portal vein, the risk of hepatic infarction and hepatic failure is high.7
Hepatic Artery Embolization for Postoperative Hemorrhage: Importance of Arterial Collateral Vessels and Portal Venous Impairment
2021, Journal of Vascular and Interventional RadiologyEndovascular treatment of postoperative hemorrhage after pancreatectomy: a retrospective study
2023, BMC GastroenterologyLate-onset hemobilia due to pseudoaneurysm rupture after endoscopic ultrasound-guided hepaticogastrostomy
2023, Clinical Journal of Gastroenterology
This work was supported by a Korea Research Foundation Grant funded by the Korean Government (KRF-2005-041-E00302). The abstract of this work was presented at the European Congress of Radiology 2009, in Vienna, Austria. None of the authors have identified a conflict of interest.