Transarterial embolization for massive gastrointestinal hemorrhage following abdominal surgery

Zhou, Chun‐Gao; Shi, Haibin; Liu, Sheng; Yang, Zhigang; Zhao, Lei; Xia, Jun; Zhou, Wei-Zhong; Linsun, Li

doi:10.3748/wjg.v19.i40.6869

Cited by 24 publications

(31 citation statements)

References 28 publications

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“… 7 , 14 However, re-operation is often difficult in the late phase as the bleeding site is difficult to find due to adhesions, inflammatory reactions, and friability of postoperative tissues. 10 , 30 The high mortality can be caused not only by massive bleeding but also by the injuries from prolonged procedures done for hemostasis. As there is an increased risk of death by the vicious cycle of hypothermia, coagulopathy, and acidosis, also known as the triad of death, 31 , 32 those cases of arterial bleeding require a damage control strategy, 33 such as abbreviated surgery or minimally invasive TAE.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis and Treatment of Abdominal Arterial Bleeding After Radical Gastrectomy: a Retrospective Analysis of 1875 Consecutive Resections for Gastric Cancer

Yang

Zhang

Huang

et al. 2016

Journal of Gastrointestinal Surgery

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BackgroundMassive abdominal arterial bleeding is an uncommon yet life-threatening complication of radical gastrectomy. The exact incidence and standardized management of this lethal morbidity are not known.MethodsBetween January 2003 and December 2013, data from 1875 patients undergoing radical gastrectomy with D2 or D2 plus lymphadenectomy were recorded in a prospectively designed database from a single institute. The clinical data and management of both early (within 24 h) and late (beyond 24 h) postoperative abdominal arterial hemorrhages were explored. For late bleeding patients, transcatheter arterial embolization (TAE) and re-laparotomy were compared to determine the better initial treatment option.ResultsThe overall prevalence of postoperative abdominal arterial bleeding was 1.92 % (n = 36), and related mortality was 33.3 % (n = 12). Early and late postoperative bleedings were found in 6 and 30 patients, respectively. The onset of massive arterial bleeding occurred on average postoperative day 19. The common hepatic artery and its branches were the most common bleeding source (13/36; 36.1 %). All the early bleeding patients were treated with immediate re-laparotomy. For late bleeding, patients from the TAE group had a significantly lower mortality rate than that of the patients from the surgery group (7.69 vs. 56.25 %, respectively, P = 0.008) as well as a shorter procedure time for bleeding control (2.3 ± 1.1 vs. 4.8 ± 1.7 h, respectively, P < 0.001). Four rescue reoperations were performed for TAE failures; the salvage rate was 50 % (2/4). Ten patients developed massive re-bleeding after initial successful hemostasis by either TAE (5/13) or open surgery (5/16). Three out of the 10 re-bleeding patients died of disseminated intravascular coagulation (DIC), while the other 7 recovered eventually by repeated TAE and/or surgery.ConclusionAbdominal arterial bleeding following radical gastrectomy tends to occur during the later phase after surgery, with further complications such as abdominal infection and fistula(s). For late bleeding, TAE can be considered as the first-line treatment when possible.Electronic supplementary materialThe online version of this article (doi:10.1007/s11605-015-3049-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

“… 3 , 9 With the advances in radiology techniques, angiography and transcatheter arterial embolization (TAE), as an alternative to re-operation, have been widely used for the diagnosis and treatment of postoperative arterial bleeding from pancreatic or other abdominal surgeries. 10 – 13 …”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Treatment of Abdominal Arterial Bleeding After Radical Gastrectomy: a Retrospective Analysis of 1875 Consecutive Resections for Gastric Cancer

Yang

Zhang

Huang

et al. 2016

Journal of Gastrointestinal Surgery

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“…Endoscopic hemostasis is considered as the treatment of choice for luminal bleeding, but there are some limitations such as poor localization of the bleeding site due to massive bleeding and not being able to reach the bleeding site because of surgical alteration. Owing to advances in procedural techniques and embolic materials, TAE has gained popularity as an effective, stand-alone treatment modality for diverse arterial bleeding [14][15][16][17]. In a similar vein, we assume that TAE can serve as the mainstay treatment for postoperative arterial bleeding.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome of transarterial embolization for postgastrectomy arterial bleeding

et al. 2017

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Transcatheter arterial embolization demonstrated high technical and clinical success rates with an acceptable complication rate in the management of postgastrectomy arterial bleeding. However, transcatheter arterial embolization may not be the best treatment option in patients who have undergone subtotal gastrectomy and bled from the splenic artery owing to the high risk of infarctions of the remnant stomach and the spleen.

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“…Contrast extravasation is direct evidence of active bleeding; however, it only occurs in a minority of patients who have GI bleeding and requires a bleeding rate of at least 0.5 mL/min for visualization (3,7,8). Commonly encountered indirect angiographic signs of bleeding include delayed focal contrast stasis, intramural pooling, aneurysm, pseudoaneurysm, arteriovenous shunt, submucosal vessel and early venous drainage of angiodysplasia, neovascularity, mucosal or extramucosal hyperemia, or arterial wall abnormalities (9).…”

Section: Discussionmentioning

confidence: 99%

Abrupt occlusion of right gastroepiploic artery as an angiographic evidence of gastrointestinal hemorrhage

et al. 2016

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Angiography plays an important role in both diagnosis and treatment of gastrointestinal (GI) bleeding; however, the sensitivity is low for diagnosis. We report a case of a 38-year-old woman who presented with recurrent upper GI bleeding following central pancreatectomy. Multiple selective arteriograms failed to reveal any active bleeding or other common signs of bleeding. There was an abrupt occlusion of the right gastroepiploic artery initially interpreted to be a surgical ligation. Upon direct superselective injection near the occlusion, an area of frank contrast extravasation was demonstrated immediately beyond the occlusion. The underlying vessel was embolized with n-butyl cyanoacrylate without recurrent bleeding up to 3-month follow-up.

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Transarterial embolization for massive gastrointestinal hemorrhage following abdominal surgery

Abstract: The positive rate of angiographic findings in 26 patients with postoperative gastrointestinal hemorrhage was 81%. Transcatheter arterial embolization seems to be an effective and safe method in the management of postoperative gastrointestinal hemorrhage.

Cited by 24 publications

References 28 publications

Diagnosis and Treatment of Abdominal Arterial Bleeding After Radical Gastrectomy: a Retrospective Analysis of 1875 Consecutive Resections for Gastric Cancer

Diagnosis and Treatment of Abdominal Arterial Bleeding After Radical Gastrectomy: a Retrospective Analysis of 1875 Consecutive Resections for Gastric Cancer

Clinical outcome of transarterial embolization for postgastrectomy arterial bleeding

Abrupt occlusion of right gastroepiploic artery as an angiographic evidence of gastrointestinal hemorrhage

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