| Endovascular management of extrahepatic artery hemorrhage after pancreatobiliary surgery: clinical features and outcomes of transcatheter arterial embolization and stent-graft placement. | |
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MedLine Citation:
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PMID: 21512055 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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OBJECTIVE: The objective of our study was to analyze the technical and clinical outcomes of endovascular treatment of patients with extrahepatic artery hemorrhage after pancreatobiliary surgery. MATERIALS AND METHODS: From January 2000 to September 2009, 27 patients who had undergone pancreaticobiliary surgery had an extrahepatic artery hemorrhage with or without a pseudoaneurysm were enrolled in this retrospective study. All patients underwent diagnostic angiography and endovascular treatment-either transcatheter arterial embolization (TAE) (n = 20) or stent-graft placement (n = 7). RESULTS: Bleeding sites were located in the gastroduodenal artery stump (n = 14), proper hepatic artery (n = 10), and common hepatic artery (n = 3). In the TAE group, the initial technical and clinical success rates were 100% and 90%, respectively. Two patients died of hepatic failure and multiorgan failure within 7 days after TAE. Hepatic ischemia and infarction were observed in six (33.3%, 6/18) and eight (44.4%, 8/18) patients, respectively. Hepatic abscess was observed in one patient (5.6%, 1/18) with hepatic infarction. The development of hepatic infarction was significantly associated with a serum aspartate aminotransferase (AST) level of more than 700 IU/L and a serum alanine transferase (ALT) level of more than 500 IU/L (p = 0.031 for both, Fisher exact test). In the stent-graft group, the initial technical and clinical success rates were 100% for both. Early stent thrombosis with bile duct necrosis was observed in one patient (14.3%). During the mean follow-up period of 22.8 months (range, 8-43 months), the intrahepatic arteries were patent on follow-up CT. CONCLUSION: The endovascular treatments of TAE and stent-graft placement can be performed safely in most patients and are effective treatment options for extrahepatic artery hemorrhage after pancreatobiliary surgery. Moreover, stent-graft placement is better than TAE for preserving intrahepatic arterial flow without rebleeding from the extrahepatic artery. |
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Authors:
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Dong Il Gwon; Gi-Young Ko; Kyu-Bo Sung; Ji Hoon Shin; Jin Hyoung Kim; Hyun-Ki Yoon |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: AJR. American journal of roentgenology Volume: 196 ISSN: 1546-3141 ISO Abbreviation: AJR Am J Roentgenol Publication Date: 2011 May |
Date Detail:
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Created Date: 2011-04-22 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7708173 Medline TA: AJR Am J Roentgenol Country: United States |
Other Details:
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Languages: eng Pagination: W627-34 Citation Subset: AIM; IM |
Affiliation:
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Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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