Stent-graft placement for hepatic arterial bleeding: assessment of technical efficacy and clinical outcome in a tertiary care center

Öcal, Osman; Mühlmann, M.; Puhr‐Westerheide, Daniel; Fabritius, Matthias P.; Deniz, Sinan; Wildgruber, Moritz; D’Haese, Jan; Werner, Jens Ulrich; Ricke, Jens; Seidensticker, Max

doi:10.1016/j.hpb.2021.09.007

Cited by 7 publications

(16 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The peripheral arterial stent-graft allowed us to preserve the hepatic blood flow when there was bleeding. There are some reports that especially for the patients with acute bleeding, stent-graft placement should be considered and its patency rates are high in the short term yet decrease as time passes [8][9][10]. Additionally, most of them stated that covered stent placement was a highly efficient, safe interventional treatment for hemorrhage associated with POPF with positive technical and clinical outcomes, although this case does not involve bleeding from CHA.…”

Section: Discussionmentioning

confidence: 96%

Endovascular Treatment of Postpancreatectomy Hemorrhage from the Retroportal Artery with Compression of the Celiac Trunk by the Median Arcuate Ligament: A Case Report

Kotera,

Tsurusaki,

Kozuki

et al. 2024

Interventional Radiology

View full text Add to dashboard Cite

Retroportal artery is one of the communicating arteries between the hepatic artery and the superior mesenteric artery, but it is often a small artery and usually unrecognized. We report a 60-year-old man that was successfully treated for postpancreatectomy hemorrhage from the retroportal artery with compression of the celiac trunk by the median arcuate ligament. Following the pancreaticoduodenectomy, the bloody discharge was discovered through the drainage catheter. We underwent transcatheter arterial embolization for the bleeding from the retroportal artery associated with a postoperative pancreatic fistula. Additionally, because a stenosis of the common hepatic artery was discovered, we consequently installed a stent-graft on the common hepatic artery to prevent the liver failure due to decreased hepatic blood flow.

show abstract

Section: Discussionmentioning

confidence: 96%

Endovascular Treatment of Postpancreatectomy Hemorrhage from the Retroportal Artery with Compression of the Celiac Trunk by the Median Arcuate Ligament: A Case Report

Kotera,

Tsurusaki,

Kozuki

et al. 2024

Interventional Radiology

View full text Add to dashboard Cite

show abstract

“…The process is tortuous, and the patient being in a severe or very critical condition makes stenting unsuitable. Previous case reports and studies have shown good results in terms of stent placement [ 10 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. Therefore, we recommend stenting if the patient has underlying liver disease ( Figure 7 ).…”

Section: Discussionmentioning

confidence: 99%

Comparing the Clinical Efficacy of Coil Embolization in GDA Stump versus Common Hepatic Artery in Postoperative Hemorrhage after Pancreatoduodenectomy

Chen

Lee

et al. 2023

JPM

View full text Add to dashboard Cite

Background: Hemorrhage after pancreaticoduodenectomy is an uncommon but fatal complication. In this retrospective study, the different treatment modalities and outcomes for treating post-pancreaticoduodenectomy hemorrhage are analyzed. Methods: Our hospital imaging database was queried to identify patients who had undergone pancreaticoduodenectomy during the period of 2004–2022. The patients were retrospectively split into three groups, according to their treatment: conservative treatment without embolization (group A: A1, negative angiography; A2, positive angiography), hepatic artery sacrifice/embolization (group B: B1, complete; B2, incomplete), and gastroduodenal artery (GDA) stump embolization (group C). Results: There were 28 patients who received angiography or transarterial embolization (TAE) treatment 41 times (cases). In group A, high re-bleeding rates (54.5%, 6/11 cases) were observed, with 44.4% (4/9 cases) for subgroup A1 and 100% (2/2 cases) for subgroup A2. In group B, the re-bleeding rates were lowest (20%, 4/20 cases) with 0% (0/16 cases) for subgroup B1 and 100% (4/4 cases) for subgroup B2. The rate of post-TAE complications (such as hepatic failure, infarct, and/or abscess) in group B was not low (35.3%, 6/17 patients), especially in patients with underlying liver disease, such as liver cirrhosis and post-hepatectomy (100% (3/3 patients), vs. 21.4% (3/14 patients); p = 0.0294, p < 0.05). The highest rate of re-bleeding (55.6%, 5/9 cases) was observed for group C. There was a significant difference in the re-bleeding rates of subgroup B1 and group C (p = 0.002). The more iterations of angiography, the higher the mortality rate (16.7% (2/12 patients), <3 times vs. 60% (3/5 patients), ≥3 times; p = 0.1165). Conclusions: The complete sacrifice of the hepatic artery is an effective first-line treatment for pseudoaneurysm or for the rupture of the GDA stump after pancreaticoduodenectomy. Hepatic complications are not uncommon and are highly associated with underlying liver disease. Conservative treatment, the selective embolization of the GDA stump, and incomplete hepatic artery embolization do not provide enduring treatment effects.

show abstract

“…However, stent-grafts are associated with a considerable risk of patency loss, especially in cases with stentgraft implantation to distal arteries. Previous studies have reported up to a 55% stent-graft occlusion during followup [38]. Early imaging follow-ups have shown partial thrombosis or edge stenoses within the stent-grafts, which indicates that the stent-graft occlusion is an ongoing process and allows development of collaterals to the liver [39].…”

Section: Arterial Interventionsmentioning

confidence: 94%

Interventional Radiology Options after Visceral Surgery

et al. 2022

View full text Add to dashboard Cite

Background: Postoperative management of patients undergoing visceral surgery can present challenging clinical situations with significant morbidity and mortality. Interventional radiological techniques offer quick, safe, and effective minimally invasive treatment options in the postoperative management of visceral surgery. Summary: Most commonly done procedures include – but are not limited to – fluid or abscess drainage, biliary diversion, bleeding embolization, and re-canalization of a thrombosed vessel. While bleeding from side branches after hepatobiliary and pancreatic surgeries can be managed by coil embolization, the hepatic arterial injury should be managed by stent-graft placement. Hepatic venous complications can require a transhepatic or transjugular approach, whereas the transjugular intrahepatic portosystemic shunt approach has a higher clinical success rate in patients with portal vein thrombosis. Biliary leakages require multidisciplinary management, and interventional radiology can offer an efficient treatment, especially in patients with biliodigestive anastomosis. Key Messages: Interventional radiology provides a broad spectrum of procedures in the management of patients with recent visceral surgery.

show abstract

Stent-graft placement for hepatic arterial bleeding: assessment of technical efficacy and clinical outcome in a tertiary care center

Cited by 7 publications

References 20 publications

Endovascular Treatment of Postpancreatectomy Hemorrhage from the Retroportal Artery with Compression of the Celiac Trunk by the Median Arcuate Ligament: A Case Report

Endovascular Treatment of Postpancreatectomy Hemorrhage from the Retroportal Artery with Compression of the Celiac Trunk by the Median Arcuate Ligament: A Case Report

Comparing the Clinical Efficacy of Coil Embolization in GDA Stump versus Common Hepatic Artery in Postoperative Hemorrhage after Pancreatoduodenectomy

Interventional Radiology Options after Visceral Surgery

Contact Info

Product

Resources

About