Stent-grafts placement for treatment of massive hemorrhage from ruptured hepatic artery after pancreaticoduodenectomy.
OBJECTIVE
To present a series of cases with life-threatening hemorrhage from ruptured hepatic artery pseudoaneurysm after pancreaticoduodenectomy (PD) treated with placement of stent-grafts.


METHODS
Massive hemorrhage from ruptured hepatic artery pseudoaneurysm after PD in 9 patients (6 men, 3 women) at the age of 23-75 years (mean 48 years), were treated with placement of percutaneous endovascular balloon-expandable coronary stent-grafts. All patients were not suitable for embolization because of a non-patent portal vein. One or more stent-grafts, ranging 3-6 mm in diameter and 16-55 mm in length, were placed to exclude ruptured pseudoaneurysm. Follow-up data, including clinical condition, liver function tests, and Doppler ultrasound examination, were recorded at the outpatient clinic.


RESULTS
Immediate technical success was achieved in all the 9 patients. All stent-grafts were deployed in the intended position for immediate cessation of bleeding and preservation of satisfactory hepatic arterial blood flow. No significant procedure-related complications occurred. Recurrent bleeding occurred in 2 patients at 16 and 24 h, respectively, after placement of stent-grafts and treated with surgical revision. One patient died of sepsis 12 d after the interventional procedure. The remaining 6 patients were survived when they were discharged. The mean follow-up time was 10.5 mo (range 4-16 mo). No patient had recurrent bleeding after discharge. Doppler ultrasound examination verified the patency of hepatic artery and stent-grafts during the follow-up.


CONCLUSIONS
Placement of stent-grafts is an effective and safe procedure for acute life-threatening hemorrhage from ruptured hepatic artery pseudoaneurysm.
Wang
Mao-Qiang
MQ
Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, China. wangmq@vip.sina.com
Liu
Feng-Yong
FY
Duan
Feng
F
Wang
Zhi-Jun
ZJ
Song
Peng
P
Fan
Qing-Sheng
QS
D000328:Adult; D000368:Aged; D017541:Aneurysm, False / Q000209:etiology / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000601:surgery; D006499:Hepatic Artery / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D012086:Reoperation; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult