Clinical StudyEndovascular Treatment of Hepatic Artery Pseudoaneurysm after Pancreaticoduodenectomy: Risk Factors Associated with Mortality and Complications
Section snippets
Patients
Forty consecutive patients who underwent EVT for post-PD hemorrhage or pseudoaneurysm between April 2004 and December 2014 were retrospectively reviewed. This study was approved by the institutional review board, and the need for informed consent from patients was waived. Twenty-eight patients who underwent post-PD EVT of the CHA and its distal arteries were included in the final analysis. Six patients who underwent EVT for other arteries (three for jejunal branches and one each for splenic,
EVT Findings
Bleeding sites included the GDA stump or CHA in 19 patients (68%), proper hepatic artery in four (14%), right hepatic artery in three (11%), and left hepatic artery in two (7%; Table 2). Portal vein stenosis was found in 16 patients (57%). The EVT techniques included coil embolization in 17 patients (61%), covered stent placement in one (3%), bare stent–assisted coil embolization in five (18%), and catheter graft with coil embolization in five (18%). In one patient who underwent coil
Discussion
EVT is widely performed to treat postoperative hemorrhage, and its effectiveness has been reported in previous studies (1,11, 12, 13, 14). However, hepatic artery embolization is occasionally associated with serious hepatic complications caused by hepatic ischemia (13, 31). Development of hepatopetal collateral vessels after EVT is associated with prevention of hepatic ischemia (13, 15, 16, 32), whereas post-EVT portal vein stenosis is associated with the poor prognosis and onset of hepatic
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2023, Journal of Vascular and Interventional RadiologyHepatic Artery Embolization for Postoperative Hemorrhage: Importance of Arterial Collateral Vessels and Portal Venous Impairment
2021, Journal of Vascular and Interventional RadiologyCitation Excerpt :Postoperative HA hemorrhage is a rare but fatal complication of PD, and endovascular treatment is considered as the first-line therapy. Of the possible endovascular treatment modalities, stent graft placement is theoretically the most desirable as it can reliably treat the hemorrhage by preserving HA flow and avoiding hepatic ischemic complications (8). However, it is frequently infeasible in many patients because of technical problems (11,15,16).
Prolonged operating time is a significant perioperative risk factor for arterial pseudoaneurysm formation and patient death following hemorrhage after pancreaticoduodenectomy
2020, PancreatologyCitation Excerpt :Notwithstanding that vital signs of shock were not selected as an independent risk factor for patient death, the mortalities related to hemorrhage were always accompanied by the presence of vital signs of shock. Previously, Hasegawa et al. reported that the presence of shock and coagulopathy were significant risk factors for patient death after PPH bleeding [5]. Therefore, it is crucial to promptly identify the presence of vital signs of shock in either early or delayed post-PD hemorrhage because it is predictive of the patient’s fatal outcome.