title: The fatal risk in hepatic artery embolization for hemostasis after pancreatic and hepatic surgery: importance of collateral arterial pathways.
abstract: OBJECTIVE
  To assess retrospectively the cause of hepatic failure related to hepatic arterial embolization (HAE) for hemostasis after pancreaticoduodenectomy or hepatic lobectomy.
  
  
  METHODS
  Between June 1993 and March 2006, Twenty HAEs in 17 patients (15 men, two women; mean age, 64 years) were performed. Angiographic findings, including portal vein stenosis, collateral arterial pathways after HAE, and the difference of embolic materials, were recorded. The morbidity (hepatic failure and abscess) and mortality were detailed according to collateral arterial pathways, portal vein stenosis, and embolic material used.
  
  
  RESULTS
  Bleeding was controlled in all patients, although two patients required repeat embolization. Hepatic failure (n = 8) and abscess (n = 2) arose in nine of 20 HAEs. Death occurred after six of eight HAEs complicated by hepatic failure. The morbidity and mortality rates of HAE were 45% and 30%, respectively. Hepatic complication was eight times more likely to occur (P = .005) in cases with no hepatic collaterals involving hepatic, replaced, or accessory hepatic arteries. Death was observed only in the cases without hepatic collaterals (P = .011). The correlation between the embolization outcome and the presence of portal vein stenosis or the difference of embolic materials was not significant (P > .61).
  
  
  CONCLUSIONS
  HAE can be used to successfully control bleeding secondary to hepatic arterial rupture. In the absence of hepatic collaterals, collateral circulation distal to the occlusion from nonhepatic sources may be inadequate and lead to hepatic failure after HAE.
authors.affiliation: Department of Radiology, Sendai Medical Center, 980-8520 Miyagino 2-8-8, Miyagino-ku, Sendai, Miyagi, Japan. satoa@rad.med.tohoku.ac.jp
authors.forename: Akihiro
authors.initials: A
authors.lastname: Sato
authors.forename: Takayuki
authors.initials: T
authors.lastname: Yamada
authors.forename: Kei
authors.initials: K
authors.lastname: Takase
authors.forename: Toshio
authors.initials: T
authors.lastname: Matsuhashi
authors.forename: Shuichi
authors.initials: S
authors.lastname: Higano
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kaneda
authors.forename: Shinichi
authors.initials: S
authors.lastname: Egawa
authors.forename: Kazunori
authors.initials: K
authors.lastname: Takeda
authors.forename: Tadashi
authors.initials: T
authors.lastname: Ishibashi
authors.forename: Shoki
authors.initials: S
authors.lastname: Takahashi
mesh_terms: D000368:Aged; D003097:Collateral Circulation; D003251:Constriction, Pathologic; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007564:Japan; D008100:Liver Abscess / Q000209:etiology / Q000401:mortality; D008102:Liver Circulation; D017093:Liver Failure / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D011172:Portography; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012421:Rupture; D013997:Time Factors; D016896:Treatment Outcome