Document Detail


Endovascular management of extrahepatic artery hemorrhage after pancreatobiliary surgery: clinical features and outcomes of transcatheter arterial embolization and stent-graft placement.
MedLine Citation:
PMID:  21512055     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
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.
Authors:
Dong Il Gwon; Gi-Young Ko; Kyu-Bo Sung; Ji Hoon Shin; Jin Hyoung Kim; Hyun-Ki Yoon
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  AJR. American journal of roentgenology     Volume:  196     ISSN:  1546-3141     ISO Abbreviation:  AJR Am J Roentgenol     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-04-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7708173     Medline TA:  AJR Am J Roentgenol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  W627-34     Citation Subset:  AIM; IM    
Affiliation:
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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