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

Abstract

Background: This study is to determine the risk factors and outcome for post-pancreaticoduodenectomy bleeding, and to assess the roles of surgery and intravascular intervention in its management. Methods: Post-pancreaticoduodenectomy data of 628 patients were analyzed with regards to post-pancreaticoduodenectomy bleeding. Results: Post-pancreaticoduodenectomy bleeding occurred in 58 patients (9.2%) and led to death in 23 patients. Pancreatic leakage and intra-abdominal abscess were independent risk factors for both extraluminal and intraluminal post-pancreaticoduodenectomy bleeding. The most common source of bleeding was the gastroduodenal artery (n = 9, 24.3%), and 8 of these patients (88.9%) experienced gastroduodenal artery bleeding in late post-pancreaticoduodenectomy bleeding. Hemostasis for post-pancreaticoduodenectomy bleeding was achieved by surgery in 22 patients (78.6%) and intravascular intervention in 7 patients (58.3%). Transarterial embolization for gastroduodenal artery bleeding did not deteriorate liver function in most patients except for 1 who died of hepatic failure. Conclusions: The placement of metallic clips on the gastroduodenal artery stump during a pancreaticoduodenectomy is helpful in identifying overlooked intermittent sentinel bleeding during angiography. Transarterial embolization for gastroduodenal artery bleeding could not guarantee against hepatic failure. The intravascular placement of a covered stent is the preferred procedure to avoid the complete interruption of arterial blood supply to the liver.

Therapeutic Management of Hemorrhage from Visceral Artery Pseudoaneurysms after Pancreatic Surgery

“…25,26 Pancreatic fistula and intra-abdominal abscess may erode the arterial wall. [27][28][29] In this study, the incidence rates of these two complications were 74.3% and 57.1%, respectively. Since they have been proven to be risk factors of postoperative massive hemorrhage, 28,29 early identification and management of these complications may help to prevent pseudoaneurysm formation after pancreatic surgery.…”

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

“…Our finding is consistent with the literatures by Sato et al [21], Yekebas et al [22] and Choi et al [38] who reported a significantly elevated risk of DPPAB in patients with pancreatic fistula. Wei et al [45] confirmed that pancreatic leakage and intra-abdominal abscess are independent risk factors for post-PD bleeding. Hence, any procedure that can prevent the formation of pancreatic fistula or intra-abdominal abscess can decrease the prevalence of DPPAB.…”

Intra‐abdominal hemorrhage following 739 consecutive pancreaticoduodenectomy: Risk factors and treatments

“…Pancreaticoduodenectomy (PD) is a complex surgery for the treatment of malignant and selected benign diseases originated from periampullary region. Although the mortality of PD has decreased significantly over the last decade, postoperative morbidity remains at 30–50% even in many high volume centers . Among all the complications, post‐PD hemorrhage (PPH) is the most lethal one, with the incidence ranging from 3% to 20%, but related mortality being as high as 20% to 50% …”