Delayed Visceral Arterial Hemorrhage Following Whipple’s Procedure: Minimally Invasive Treatment with Covered Stents

Abstract

Minimally invasive therapy using low-profile stent grafts is an effective and safe procedure for the treatment of delayed visceral arterial hemorrhage following Whipple's procedure. The technique is a promising alternative to standard procedures such as surgical repair or embolization.

Management of Delayed Post-Pancreaticoduodenectomy Arterial Bleeding: Interventional Radiological Treatment First

“…When referring to post-pancreatectomy bleeding, most authors claimed that bleeding at the early and late stage should be categorized as different entities [10,12,19,22,23,32,33]. Late bleeding after PD usually occurred >5–7 days postoperatively, with the time interval between the index operation and delayed bleeding ranging from 5 to 206 days [11,20,21,25,27,34,35,36,37]. In our study, the mean time of DPPAB was 33 days (range 7–72) postoperatively.…”

“…With recent advances in interventional radiology, transcatheter arterial embolization (TAE) has become more widely used. Various authors researching TAE for postoperative bleeding have reported a prevalence of success of 55–100% [11,15,19,21,22,25,26,27,28]. …”

Risk Factors for Post-Pancreaticoduodenectomy Bleeding and Finding an Innovative Approach to Treatment

“…Our cases also show that the recent use of covered stents may prove to be a successful solution to resolve this issue. A covered stent makes it possible to arrest the bleeding while preserving the patency of the vessels [3, 10, 12,15,16,17]. Potential disadvantages of the covered stent include a longer duration to achieve hemostasis as compared to transarterial embolization, risk of arterial rupture due to low flexibility and fragile vascular walls, and technical difficulties in negotiating with torturous arteries [3].…”

“…The endoscopic approach is feasible mainly for gastrointestinal (intraluminal) bleeding; reoperation is traditionally reserved for intra-abdominal (extraluminal) bleeding, but carries substantial morbidity and mortality for late bleeding [3, 10]. Intravascular intervention, such as transarterial embolization or the placement of covered stents to occlude the orifice of the bleeding vessel, is a minimally invasive procedure and can be considered as a good alternative to reoperation [2,3, 5,9,10,11,12,13,14,15,16,17,18,19,20]. Therefore, determining the risk factors for post-pancreaticoduodenectomy bleeding and accumulating treatment experience is of utmost importance for pancreatic surgeons.…”

Endovascular management of bleeding events after robotic pancreaticobiliary surgery

“…With the rise of image-guided and catheter-based therapies, endovascular techniques have become an accepted treatment option for postoperative bleeding complications (5,6). While endovascular methods for addressing bleeding after pancreatic surgery have been described (7), there are limited data on the application of such approaches after minimally invasive robotic pancreaticobiliary surgery. In this retrospective study, we report our initial experience with the endovascular treatment of bleeding events following robotic pancreaticobiliary surgery, discuss our management approach and interventional techniques, and highlight the utility of minimally invasive catheter-directed therapies in these challenging surgical patients.…”