Superselective Microcoil Embolization: Treatment of Choice in High-Risk Patients With Extrahepatic Pseudoaneurysms of the Hepatic Arteries

Reber, P. U.; Baer, H. U.; Patel, Ameet G.; Wildi, Stephan M.; Triller, Jürgen; Büchler, Markus W.

doi:10.1016/s1072-7515(98)00032-5

Cited by 114 publications

(69 citation statements)

References 28 publications

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“…For stable, nonruptured HAPA, occlusion is achieved by embolization in 88%-100% of cases (19,20). Good results of embolization for even ruptured HAPA have been reported (21). There have been isolated reports of hepatic necrosis after embolization, probably as the result of nonselective deployment or embolization in the presence of an occluded portal vein (22).…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal hemorrhage caused by rupture of a pseudoaneurysm of the hepatic artery

Doğan

Yıldırım²,

Göktürk³

2012

Turk J Gastroenterol

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Section: Discussionmentioning

confidence: 99%

Gastrointestinal hemorrhage caused by rupture of a pseudoaneurysm of the hepatic artery

Doğan

Yıldırım²,

Göktürk³

2012

Turk J Gastroenterol

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“…Therefore, when performing hepatic TAE, all the information mentioned above should be considered in individual patients who have undergone hepatobiliary pancreatic surgery. TAE on the hepatic artery has generally been considered to be relatively safe if the portal blood flow is maintained [12,13,24] . However, it could result in an unfavorable outcome when the development of extrahepatic pathways to the liver is poor.…”

Section: Discussionmentioning

confidence: 99%

“…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] . Furthermore, hepatic TAE may cause a total interruption of the arterial blood supply to the liver, thus www.wjgnet.com presenting a risk for liver infarction, especially in patients after right or left hepatic lobectomy [11][12][13][14] . In this study, we retrospectively reviewed the patients who underwent TAE for a r uptured hepatic arter y pseudoaneurysm following major hepatobiliary pancreatic surgery, paying special attention to the extrahepatic collateral pathways which may be associated with post-TAE liver damage and a negative patient outcome.…”

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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“…TAE is characterized by its high success rate accompanied by relatively low morbidity and mortality rates, thus, avoiding emergency surgery associated with multiple risks, especially in multimorbid patients [9].…”

mentioning

confidence: 99%

Transcatheter arterial embolisation in upper gastrointestinal bleeding in a sample of 29 patients in a gastrointestinal referral center in Germany

et al. 2015

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Objective: This is a retrospective analysis of interventional embolisation performed with catheter angiography in 29 patients with upper gastrointestinal bleeding in the setting of a secondary care hospital. Patients, Materials, and Methods: From April 2007 to February 2013, 29 patients with upper gastrointestinal bleeding underwent endovascular diagnostics and treatment. The diagnosis was established by endoscopy, computed tomography or clinically based on a significant decrease in hemoglobin. Transcatheter arterial embolisation was performed with coils, liquid embolic agents, and particles. The technical and clinical outcomes were assessed by postinterventional endoscopy, hemoglobin concentrations, number of necessary transfusions, or surgical interventions, as well as by post-interventional mortality within 28 days after the procedure. Results: Selective angiographic embolisation in upper gastrointestinal bleeding was primarily successful technically and clinically in 22 of 29 patients. In 4/29 cases an angiographic reintervention was performed, which was successful in 3?cases. In 3 cases of primarily technically unsuccessful procedures reintervention was not attempted. No catheterisation-related complications were recorded. Peri-interventional mortality was 31?%, but only 2 of these patients died due to uncontrolled massive bleeding, whereas the lethal outcome in the other 7 patients was due to their underlying diseases. Conclusion: Transcatheter arterial embolisation is an effective and rapid method in the management of upper gastrointestinal bleeding. Radiological endovascular interventions may considerably contribute to reduced mortality in GI bleeding by avoiding a potential surgical procedure following unsuccessful endoscopic treatment. The study underlines the importance of the combination of interventional endoscopy with interventional radiology in secondary care hospitals for patient outcome in complex and complicated upper gastrointestinal bleeding situations.

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Superselective Microcoil Embolization: Treatment of Choice in High-Risk Patients With Extrahepatic Pseudoaneurysms of the Hepatic Arteries

Cited by 114 publications

References 28 publications

Gastrointestinal hemorrhage caused by rupture of a pseudoaneurysm of the hepatic artery

Gastrointestinal hemorrhage caused by rupture of a pseudoaneurysm of the hepatic artery

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

Transcatheter arterial embolisation in upper gastrointestinal bleeding in a sample of 29 patients in a gastrointestinal referral center in Germany

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