Clinical study
Superselective Embolization for the Management of Postpancreatectomy Hemorrhage: A Single-Center Experience in 25 Patients

https://doi.org/10.1016/j.jvir.2011.12.013Get rights and content

Abstract

Purpose

To evaluate the efficacy of superselective embolization in patients with late postpancreatectomy hemorrhage (PPH).

Materials and Methods

Between January 2002 and July 2010, 25 patients (19 men) with suspected late PPH (> 24 hours after the operation) were evaluated. The primary study endpoint was technical success, defined as complete angiographic occlusion of the site of hemorrhage. Secondary study endpoints were multidetector computed tomography (CT) and angiographic findings regarding accurate detection of the site of hemorrhage, persistence of hemorrhage, or occurrence of rebleeding during clinical follow-up.

Results

Multidetector CT was performed before the intervention in 17 (68%) patients with detection of hemorrhage in 15 (88%) patients. The site of hemorrhage was detected in 23 (92%) of 25 patients by angiography. Four (17%) patients required a superselective catheter position. Embolization was attempted in all 23 patients with angiographically visible hemorrhage. In three (13%) patients, embolization could not be performed because a superselective catheter position was not achievable. Technical success was 83% (19 patients). In one patient, hemostasis was not achieved by embolization. Minor complications occurred in three (13%) patients. No major complications occurred. Three patients with technically successful embolization (16%) had a second episode of bleeding during follow-up and required repeat embolization 5–23 days after the procedure. The 30-day mortality rate was 20%.

Conclusions

Superselective embolization is a technically and clinically effective procedure in patients with late PPH. Diagnostic angiography should be performed with a superselective microcatheter position to detect the bleeding site effectively.

Section snippets

Patients

Data were obtained from a prospective clinical database and reviewed for patients undergoing angiography for suspected late PPH between January 2002 and July 2010. Institutional review board approval was obtained for this retrospective study. Hemorrhage was suspected when one or more of the following signs were observed: fresh blood loss through abdominal drains or nasogastric tubes, hematemesis or melena, unexplained hypotension or tachycardia, or decrease in hemoglobin (9).

Postoperative late

Patients

Between January 2002 and July 2010, 4,295 patients underwent pancreatic surgery at our hospital. Of these patients, 25 (19 males) were scheduled for emergency embolization for suspected late PPH 33.3 days ± 55.8 after surgery (range 5–292 days, median 22 days). Mean age of patients was 59 years ± 11 (range 29–73 years, median 62 years). Surgical procedures are shown in the Table. Six (24%) patients had suspected sentinel bleeding. Mean initial hemoglobin value was 7.2 g/dL (range 3.0–10.3

Discussion

Pseudoaneurysms are a common finding in patients with late hemorrhage after pancreatic surgery (18). In our study, pseudoaneurysms caused arterial hemorrhage in 7 (30%) patients. Most cases originated from the hepatic artery. Frequently, sentinel bleeding precedes massive hemorrhage. In a study by de Castro et al (12), 78% of patients showed sentinel bleeding within a mean postoperative interval of 17.6 days. Tien et al (10) observed sentinel bleeding in 20 (7%) of 283 patients undergoing

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    None of the authors have identified a conflict of interest.

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