Delayed visceral arterial hemorrhage following Whipple's procedure: minimally invasive treatment with covered stents.
BACKGROUND
Delayed visceral arterial hemorrhage caused by inflammatory vessel erosion represents a rare but life-threatening complication after pancreatic head resection. Therapeutic options include reoperation or endovascular minimally invasive techniques such as embolization or stent graft placement. The present article describes our experiences with implantation of newly developed low-profile stent grafts.


METHODS
The findings of four patients with delayed visceral arterial hemorrhage are described. All patients were treated with placement of low-profile stent grafts. The patients' medical records, radiological reports, and images were retrospectively reviewed. Technical success was defined as immediate cessation of hemorrhage. Clinical success was defined as hemodynamic stability.


RESULTS
A total of seven stent grafts were implanted in four arteries. In detail, one stent graft was placed in the splenic artery of the first and second patients. In the third patient one stent graft was initially implanted in the common hepatic artery. The patient developed recurrent hemorrhages of the common hepatic artery, treated one time surgically and two times by deployment of a second and third stent graft. In the fourth patient two stent grafts were placed in the proper hepatic artery. Technical and clinical success was achieved at every procedure. Apart from recurrent hemorrhage of patient No. 3 there were no major complications.


CONCLUSIONS
Minimally invasive therapy using low-profile stent grafts is an effective and safe procedure for the treatment of delayed visceral arterial hemorrhage following Whipple's procedure. The technique is a promising alternative to standard procedures such as surgical repair or embolization.
Heiss
Peter
P
Department of Radiology, University Regensburg, Regensburg, Germany. heiss.peter@web.de
Bachthaler
Maike
M
Hamer
Okka Wilkea
OW
Piso
Pompiliu
P
Herold
Thomas
T
Schlitt
Hans Juergen
HJ
Feuerbach
Stefan
S
Zorger
Niels
N
D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D004067:Digestive System Neoplasms / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000628:therapy*; D012189:Retrospective Studies; D013152:Splanchnic Circulation; D015607:Stents; D013997:Time Factors