Treatment of acute delayed visceral hemorrhage after pancreatic surgery from hepatic arteries with covered stents.
BACKGROUND
Delayed visceral hemorrhage following pancreatic surgery is a rare but life-threatening complication. Usually hemorrhage originates from pseudoaneurysms secondary to pancreatic or biliary fistula. Re-laparotomy is often associated with high morbidity and mortality. Endovascular occlusion with metallic coils can stop pseudoaneurysmatic bleeding, but hepatic artery occlusion can result in severe organ damage. Interventional treatment with covered stents is an alternative providing persistent organ perfusion.


RESULTS
In our department endovascular stenting for visceral hemorrhage was introduced in November 2008. From November 2008 until October 2009, 303 patients underwent pancreatic surgery at our institution. Among those, four patients were successfully treated with covered stents for delayed visceral hemorrhage. In all four patients bleeding originated from hepatic arteries. Mean onset of hemorrhage was 24 days after surgery. Endovascular stenting was successful in all four patients. None of these patients required re-operation or died during the study.


CONCLUSIONS
Treatment of delayed visceral hemorrhage from hepatic arteries after pancreatic surgery with covered stents is safe and effective. Endovascular stenting is associated with a lower morbidity than re-laparotomy or coil embolisation. Emergency angiography with endovascular stenting should be considered for all patients with delayed hemorrhage from hepatic arteries after pancreatic surgery.
Department of Surgery, St. Josef Hospital, Ruhr-University of Bochum, School of Medicine, Bochum, Germany.
Torsten
T
Herzog
Dominique
D
Suelberg
Orlin
O
Belyaev
Waldemar
W
Uhl
Marcus
M
Seemann
Matthias H
MH
Seelig
D017541:Aneurysm, False / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D057510:Endovascular Procedures; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D008297:Male; D010180:Pancreatectomy / Q000009:adverse effects; D010182:Pancreatic Diseases / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000601:surgery*; D013152:Splanchnic Circulation; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
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