Use of a Stent Graft for Bleeding Hepatic Artery Pseudoaneurysm Following Pancreaticoduodenectomy

Abstract

Although uncommon, bleeding following pancreaticoduodenectomy is associated with high mortality. Management generally includes surgical reexploration or, alternatively, transarterial embolization. We report the case of a 62-year-old man who presented with massive upper gastrointestinal bleeding 3 weeks after pancreaticoduodenectomy. Selective coeliac angiography revealed a large pseudoaneurysm involving the proper hepatic artery. This was treated successfully with a stent graft. There was no recurrence of bleeding at the 6-month follow-up. To our knowledge, this is the first report of stent graft repair of bleeding hepatic artery pseudoaneurysm following pancreaticoduodenectomy.

Emergency stent graft implantation for ruptured visceral artery pseudoaneurysm

“…However, we believe that this technique can be proposed for all patients with visceral pseudoaneurysms and suitable anatomy, and not only for patients with failed embolization or those with a high risk of organ infarction, as recommended by some authors. 16 …”

“…[8][9][10][11][12] Reports have emerged describing stent graft exclusion of pseudoaneurysm as an alternative that compensates for the disadvantages of embolization. [13][14][15][16] These reports concern individual cases or small series with only short-term results. 17 The present article describes our experience with stent graft deployment in the treatment of ruptured visceral artery pseudoaneurysms after operations or trauma and analyzes the midterm results.…”

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

“…Our cases also show that the recent use of covered stents may prove to be a successful solution to resolve this issue. A covered stent makes it possible to arrest the bleeding while preserving the patency of the vessels [3, 10, 12,15,16,17]. Potential disadvantages of the covered stent include a longer duration to achieve hemostasis as compared to transarterial embolization, risk of arterial rupture due to low flexibility and fragile vascular walls, and technical difficulties in negotiating with torturous arteries [3].…”

“…The endoscopic approach is feasible mainly for gastrointestinal (intraluminal) bleeding; reoperation is traditionally reserved for intra-abdominal (extraluminal) bleeding, but carries substantial morbidity and mortality for late bleeding [3, 10]. Intravascular intervention, such as transarterial embolization or the placement of covered stents to occlude the orifice of the bleeding vessel, is a minimally invasive procedure and can be considered as a good alternative to reoperation [2,3, 5,9,10,11,12,13,14,15,16,17,18,19,20]. Therefore, determining the risk factors for post-pancreaticoduodenectomy bleeding and accumulating treatment experience is of utmost importance for pancreatic surgeons.…”

Hemobilia and cystic artery stump pseudoaneurysm associated with liver abscess after a laparoscopic cholecystectomy: Report of a case

“…Recently, some reports have described the usefulness of a cover stent for the treatment of hepatic artery PA after a pancreaticoduodenectomy in order to maintain the arterial fl ow in the liver. 14,15 In our case, the collateral fl ow was observed after endovascular balloon occlusion of the RHA at the second embolization, although the collateral fl ow might have developed after the fi rst embolization of the PA sack. In the absence of a collateral fl ow, a cover stent might therefore be useful for hepatic artery PA occlusion while maintaining the arterial fl ow to the liver.…”