Successful Nonoperative Management of Bleeding Hepatic Artery Pseudoaneurysm following Pancreaticoduodenectomy

Aranha, Gerard V.; O'Neil, Stephen; Borge, Marc A.

doi:10.1159/000018783

Cited by 27 publications

(22 citation statements)

References 9 publications

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“…The recommended intervention of this entity includes computed tomography scan,angiography which offers the option of embolization and three-dimensional angiographic imaging helical CT [15,31,32,33]. Transcatheter arterial embolization (TAE) has been efficacious for the treatment of pseudoaneurysms associated with pancreatitis [25, 34] and post-PD [11,35,36,37,38,39]. Emergency surgery for pseudoaneurysms is often hazardous and remains the solution to haemodynamically unstable patients and after failure of angiographic embolization [31].…”

Section: Discussionmentioning

confidence: 99%

Haemorrhage following Pancreaticoduodenectomy: Risk Factors and the Importance of Sentinel Bleed

Koukoutsis¹,

Bellagamba²,

Morris‐Stiff³

et al. 2006

Dig Surg

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Aim: To document the prevalence and to evaluate the management strategies of haemorrhagic complications following pancreaticoduodenectomy (PD). Methods: All patients who underwent PD from 1/2000 to 10/2005 and experienced at least one episode of haemorrhage during the 30 first days postoperatively were recorded. Etiology of haemorrhage, treatment strategy and mortality rate were recorded and analyzed. Results: A total of 362 patients underwent PD during this period and 32 (8.8%) had haemorrhage postoperatively of whom 15 died (47% mortality rate). Primary intraluminal haemorrhage was recorded in 13 patients, primary intra-abdominal haemorrhage in 5 patients and secondary haemorrhage in 14 patients. Successful management of haemorrhage with angioembilization occurred in 2 patients in the study group. Statistical analysis revealed sepsis and sentinel bleed as risk factors for post-PD haemorrhage and pancreatic leak and sentinel bleed as risk factors for secondary haemorrhage (p < 0.05). Conclusions: Haemorrhage after PD is a life-threatening complication. Sepsis, pancreatic leak, and sentinel bleed are statistical significant factors predicting post-PD haemorrhage. Sentinel bleed is not statistically significant associated with postoperative mortality, but with the onset of secondary haemorrhage. The effectiveness of therapeutic angioembolization was not demonstrated in our study.

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Section: Discussionmentioning

confidence: 99%

Haemorrhage following Pancreaticoduodenectomy: Risk Factors and the Importance of Sentinel Bleed

Koukoutsis¹,

Bellagamba²,

Morris‐Stiff³

et al. 2006

Dig Surg

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“…Transcatheter arterial embolization (TAE) has been proposed as the first-line treatment to control massive bleeding associated with a r uptured hepatic arter y pseudoaneurysm after hepatobiliary pancreatic surgery because of its advantages over surgery. Such advantages include an easier approach, precise localization of the pseudoaneurysm, assessment of collateral pathways to the liver, less chance of re-bleeding, and low mortality rates [1][2][3][4][5][6][7] . Meanwhile, TAE on the hepatic artery may lead to liver abscesses, gallbladder necrosis, biliary stricture, intrahepatic biloma, and embolization of nor mal vessels [8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

Extrahepatic collaterals and liver damage in embolotherapy for ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery

Tajima

Kuroki²,

Tsutsumi³

et al. 2007

WJG

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AIM:To evaluate the effects of extrahepatic collaterals to the liver on liver damage and patient outcome after embolotherapy for the ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery. METHODS:We reviewed 9 patients who underwent transcatheter arterial embolization (TAE) for the ruptured hepatic artery pseudoaneurysm following major hepatobiliary pancreatic surgery between June 1992 and April 2006. We paid special attention to the extrahepatic arterial collaterals to the liver which may affect post-TAE liver damage and patient outcome. RESULTS:The underlying diseases were all malignancies, and the surgical procedures included hepatopancreatoduodenectomy in 2 patients, hepatic resection with removal of the bile duct in 5, and pancreaticoduodenectomy in 2. A total of 11 pseudoaneurysm developed: 4 in the common hepatic artery, 4 in the proper hepatic artery, and 3 in the right hepatic artery. Successful hemostasis was accomplished with the initial TAE in all patients, except for 1. Extrahepatic arterial pathways to the liver, including the right inferior phrenic artery, the jejunal branches, and the aberrant left hepatic artery, were identified in 8 of the 9 patients after the completion of TAE. The development of collaterals depended on the extent of liver mobilization during the hepatic resection, the postoperative period, the presence or absence of an aberrant left hepatic artery, and the concomitant arterial stenosis adjacent to the pseudoaneurysm. The liver tolerated TAE without significant consequences when at least one of the collaterals from the inferior phrenic artery or the aberrant left hepatic artery was present. One patient, however, with no extrahepatic collaterals died of liver failure due to total liver necrosis 9 d after TAE. CONCLUSION:When TAE is performed on ruptured hepatic artery pseudoaneurysm, reduced collateral pathways to the liver created by the primary surgical procedure and a short postoperative interval may lead to an unfavorable outcome.

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“…Early bleeding is most often the result of insufficient intra-operative haemostasis at the abdominal vessels or may originate from the visceral anastomotic suture line. Immediate surgery is usually compulsory [2, 3, 4]. Late post-operative haemorrhage (up to 2 weeks after the operation) is a serious complication, the second most common following sepsis from dehiscence of the pancreatojejunal anastomosis [4].…”

Section: Discussionmentioning

confidence: 99%

“…Immediate surgery is usually compulsory [2, 3, 4]. Late post-operative haemorrhage (up to 2 weeks after the operation) is a serious complication, the second most common following sepsis from dehiscence of the pancreatojejunal anastomosis [4]. The site of late bleeding is more difficult to diagnose; the best treatment is still uncertain [3].…”

Section: Discussionmentioning

confidence: 99%

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Gastroduodenal Artery Stump Haemorrhage following Pylorus-Sparing Whipple Procedure: Treatment with Covered Stents

Mansueto¹,

D’Onofrio²,

Iacono

et al. 2002

Dig Surg

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Background/Aims: To report a case of bleeding after pancreatoduodenectomy in a patient with pancreatic leak and portal thrombosis who was successfully treated with an endovascular approach. Methods: A 58-year-old male, suffering from neoplasm of the distal bile duct, underwent a pylorus-preserving Whipple procedure. On the 18th day, following a sudden drop in pressure and low haematocrit values, the patient underwent surgery. The source of the bleeding was not found. Six days later, following the appearance of bleeding from the abdominal drainage and haematemesis with shock, the patient had an immediate angiography. Bleeding from the gastroduodenal artery stump was evident, the portography showed no portal flow. With respect to the shortness of the stump, safe embolisation with coils, while preserving the common hepatic artery patency, was difficult to obtain. Results: By transcatheter placement of covered stents into the hepatic artery and thereby occluding the origin of the gastroduodenal artery, the bleeding was stopped. After 2 months, CT angiography showed patency of both the common and proper hepatic arteries. Nine months after the procedure the patient is in good health. Conclusions: Percutaneous placement of covered stents can be the solution in cases where transcatheter embolisation is not recommendable because of portal vein thrombosis.

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Successful Nonoperative Management of Bleeding Hepatic Artery Pseudoaneurysm following Pancreaticoduodenectomy

Cited by 27 publications

References 9 publications

Haemorrhage following Pancreaticoduodenectomy: Risk Factors and the Importance of Sentinel Bleed

Haemorrhage following Pancreaticoduodenectomy: Risk Factors and the Importance of Sentinel Bleed

Extrahepatic collaterals and liver damage in embolotherapy for ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery

Gastroduodenal Artery Stump Haemorrhage following Pylorus-Sparing Whipple Procedure: Treatment with Covered Stents

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