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Endovascular Management of Pancreatitis Related Bleeding: Single-Centre Experience
22 March 2018 (online)
Purpose To assess the outcome of endovascular interventions in the management of pancreatitis related bleeding.
Materials and Methods Retrospective analysis of patients referred for endovascular management of pancreatitis-related bleeding from January 2009 to December 2016 was done. Patients’ demography, angiography findings, details of endovascular procedure, technical outcome, clinical outcome, and complications were assessed.
Results A total of 105 patients (99 male and 6 female) with mean age of 37 years (range: 7–73 years) were included in the study. Splenic artery (41%) was the most commonly involved vessel. Middle colic, left colic, superior mesenteric artery (SMP0, jejunal, left inferior phrenic, and left renal subcapsular arteries were the uncommonly involved vessels. Embolization was done using coils in 72 (68.5%) patients, N-butyl cyanoacrylate (NBCA) in 21 (20%) patients, and both coil and NBCA in 8 (7.6%) patients, and 4 (3.8%) patients underwent stent graft placement. Technical success was achieved in 98% (n = 103) of patients. Hemostasis was not achieved in two patients who underwent surgery. Clinical success was achieved in 93.2% (n = 96) of patients. Re-bleeding was seen in 6.8% (n = 7) of patients. Six patients with re-bleeding were managed by re-intervention. Four patients had re-bleeding from same vessel, and two patients had bleeding from different vessel. One patient died due to massive re-bleeding. Minor complications were seen in 14.2% (n = 15) of patients, and major complications were seen in 3.8% (n = 4) of patients. Mortality rate was 0.9% (n = 1).
Conclusion Endovascular treatment is effective in management of pancreatitis-related bleeding and is associated with a low re-bleeding rate as well as with a low mortality rate.