Download PDF
CC BY 4.0 · The Arab Journal of Interventional Radiology 2023; 07(02): 100-106
DOI: 10.1055/s-0043-1772256
Original Article

Endovascular Management of Postoperative Hemorrhage after Pancreaticoduodenectomy

Mohd Shariq
1   Interventional Radiology, Queens Hospital, Romford, United Kingdom
,
Kunal Gala 
2   Department of Radio-Diagnosis, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
3   Department of Radiology, Homi Bhabha National University (HBNI), Mumbai, India
,
Aditi Gandhi
4   Interventional Radiology, Sushrut Hospital, Ahmedabad, Gujrat, India
,
Rozil Gandhi
4   Interventional Radiology, Sushrut Hospital, Ahmedabad, Gujrat, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objective The aim of the study was to assess the safety and efficacy of endovascular management for postpancreaticoduodenectomy hemorrhage.

Materials and Methods A retrospective analysis of patients who underwent endovascular management for hemorrhage after pancreatic surgery between January 2015 to December 2020 was performed. Patient demographics, clinical presentation, angiography findings, endovascular procedure, technical success, clinical success, and complications were assessed.

Results Seventeen patients, comprising 14 (82.4%) males and 3 (17.6%) females, aged 37 to 68 years underwent endovascular management for postpancreatectomy hemorrhage. Patients presented with hemorrhage on their postoperative days 4 to 22 (mean: 9.8th day; median: 8th day); the presentation was with extraluminal hemorrhage in 11 patients (64.7%) and intraluminal hemorrhage in 6 patients (35.2%). The gastroduodenal artery (GDA) stump (10 patients, 58.8%) was the most commonly involved artery. The majority of cases were treated using coils as embolizing agents (13/17 patients, 76.5%). The technical and clinical success rates were 100%. The complication rate was 5.9% (1/17) and the mortality rate was 11.8% (2/17). The relaparotomy rate was 23.5% (4/17); however, none of the relaparotomy was for hemorrhage.

Conclusion Endovascular treatment provides a minimally invasive, safe, and effective method for the management of pancreaticoduodenectomy hemorrhage.

Keywords

endovascular - gastroduodenal artery - interventional radiology - postpancreaticoduodenectomy hemorrhage

Authors' Contribution

R.G. was responsible for conceptualization, data curation, and methodology. M.S. was responsible for formal analysis, writing of the original draft, and resources and literature review. A.G. was responsible for the software. Writing and review and editing were done by K.G. and R.G.




Publication History

Article published online:
13 November 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Yeo CJ, Cameron JL, Sohn TA. et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 1997; 226 (03) 248-257 , discussion 257–260
    CrossrefPubMedGoogle Scholar
  • 2 Neoptolemos JP, Russell RCG, Bramhall S, Theis B. UK Pancreatic Cancer Group. Low mortality following resection for pancreatic and periampullary tumours in 1026 patients: UK survey of specialist pancreatic units. Br J Surg 1997; 84 (10) 1370-1376
    PubMedGoogle Scholar
  • 3 Büchler MW, Wagner M, Schmied BM, Uhl W, Friess H, Z'graggen K. Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy. Arch Surg 2003; 138 (12) 1310-1314 , discussion 1315
    CrossrefPubMedGoogle Scholar
  • 4 Trede M, Schwall G. The complications of pancreatectomy. Ann Surg 1988; 207 (01) 39-47
    CrossrefPubMedGoogle Scholar
  • 5 Miedema BW, Sarr MG, van Heerden JA, Nagorney DM, McIlrath DC, Ilstrup D. Complications following pancreaticoduodenectomy. Current management. Arch Surg 1992; 127 (08) 945-949 , discussion 949–950
    CrossrefPubMedGoogle Scholar
  • 6 Wente MN, Veit JA, Bassi C. et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 2007; 142 (01) 20-25
    CrossrefPubMedGoogle Scholar
  • 7 Yekebas EF, Wolfram L, Cataldegirmen G. et al. Postpancreatectomy hemorrhage: diagnosis and treatment: an analysis in 1669 consecutive pancreatic resections. Ann Surg 2007; 246 (02) 269-280
    CrossrefPubMedGoogle Scholar
  • 8 Das S, Ray S, Mangla V. et al. Post pancreaticoduodenectomy hemorrhage: a retrospective analysis of incidence, risk factors and outcome. Saudi J Gastroenterol 2020; 26 (06) 337-343
    CrossrefPubMedGoogle Scholar
  • 9 van Berge Henegouwen MI, Allema JH, van Gulik TM, Verbeek PCM, Obertop H, Gouma DJ. Delayed massive haemorrhage after pancreatic and biliary surgery. Br J Surg 1995; 82 (11) 1527-1531
    CrossrefPubMedGoogle Scholar
  • 10 Rumstadt B, Schwab M, Korth P, Samman M, Trede M. Hemorrhage after pancreatoduodenectomy. Ann Surg 1998; 227 (02) 236-241
    CrossrefPubMedGoogle Scholar
  • 11 Zealley IA, Tait IS, Polignano FM. Delayed massive hemorrhage after pancreatic and biliary surgery: embolization or surgery?. Ann Surg 2006; 243 (01) 138-139 , author reply 139
    CrossrefPubMedGoogle Scholar
  • 12 Tien YW, Lee PH, Yang CY, Ho MC, Chiu YF. Risk factors of massive bleeding related to pancreatic leak after pancreaticoduodenectomy. J Am Coll Surg 2005; 201 (04) 554-559
    CrossrefPubMedGoogle Scholar
  • 13 Mañas-Gómez MJ, Rodríguez-Revuelto R, Balsells-Valls J. et al. Post-pancreaticoduodenectomy hemorrhage. Incidence, diagnosis, and treatment. World J Surg 2011; 35 (11) 2543-2548
    CrossrefPubMedGoogle Scholar
  • 14 Sanjay P, Fawzi A, Fulke JL. et al. Late post pancreatectomy haemorrhage. Risk factors and modern management. JOP 2010; 11 (03) 220-225
    Google Scholar
  • 15 Zhou TY, Sun JH, Zhang YL. et al. Post-pancreaticoduodenectomy hemorrhage: DSA diagnosis and endovascular treatment. Oncotarget 2017; 8 (43) 73684-73692
    CrossrefPubMedGoogle Scholar
  • 16 Choi SH, Moon HJ, Heo JS, Joh JW, Kim YI. Delayed hemorrhage after pancreaticoduodenectomy. J Am Coll Surg 2004; 199 (02) 186-191
    CrossrefPubMedGoogle Scholar
  • 17 Hur S, Yoon CJ, Kang SG. et al. Transcatheter arterial embolization of gastroduodenal artery stump pseudoaneurysms after pancreaticoduodenectomy: safety and efficacy of two embolization techniques. J Vasc Interv Radiol 2011; 22 (03) 294-301
    CrossrefPubMedGoogle Scholar
  • 18 Stampfl U, Hackert T, Sommer CM. et al. Superselective embolization for the management of postpancreatectomy hemorrhage: a single-center experience in 25 patients. J Vasc Interv Radiol 2012; 23 (04) 504-510
    CrossrefPubMedGoogle Scholar
  • 19 Ching KC, Santos E, McCluskey KM. et al. Covered stents and coil embolization for treatment of postpancreatectomy arterial hemorrhage. J Vasc Interv Radiol 2016; 27 (01) 73-79
    CrossrefPubMedGoogle Scholar
  • 20 Roulin D, Cerantola Y, Demartines N, Schäfer M. Systematic review of delayed postoperative hemorrhage after pancreatic resection. J Gastrointest Surg 2011; 15 (06) 1055-1062
    CrossrefPubMedGoogle Scholar
  • 21 Brodsky JT, Turnbull AD. Arterial hemorrhage after pancreatoduodenectomy. The “sentinel bleed.”. Arch Surg 1991; 126 (08) 1037-1040
    CrossrefPubMedGoogle Scholar
  • 22 Khalsa BS, Imagawa DK, Chen JI, Dermirjian AN, Yim DB, Findeiss LK. Evolution in the treatment of delayed postpancreatectomy hemorrhage: surgery to interventional radiology. Pancreas 2015; 44 (06) 953-958
    CrossrefPubMedGoogle Scholar
  • 23 Biondetti P, Fumarola EM, Ierardi AM, Carrafiello G. Bleeding complications after pancreatic surgery: interventional radiology management. Gland Surg 2019; 8 (02) 150-163
    CrossrefPubMedGoogle Scholar
  • 24 Sato A, Yamada T, Takase K. et al. The fatal risk in hepatic artery embolization for hemostasis after pancreatic and hepatic surgery: importance of collateral arterial pathways. J Vasc Interv Radiol 2011; 22 (03) 287-293
    CrossrefPubMedGoogle Scholar
  • 25 Baker TA, Aaron JM, Borge M, Pierce K, Shoup M, Aranha GV. Role of interventional radiology in the management of complications after pancreaticoduodenectomy. Am J Surg 2008; 195 (03) 386-390 , discussion 390
    CrossrefPubMedGoogle Scholar
  • 26 Sanjay P, Kellner M, Tait IS. The role of interventional radiology in the management of surgical complications after pancreatoduodenectomy. HPB (Oxford) 2012; 14 (12) 812-817
    CrossrefPubMedGoogle Scholar