title: Transcatheter arterial embolization of gastroduodenal artery stump pseudoaneurysms after pancreaticoduodenectomy: safety and efficacy of two embolization techniques.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of two transcatheter arterial embolization (TAE) techniques used to treat pseudoaneurysms of the gastroduodenal artery (GDA) stump after pancreaticoduodenectomy.
  
  
  METHODS
  Between March 2003 and March 2008, 16 patients were treated with TAE for pseudoaneurysms of the GDA stump after pancreaticoduodenectomy. Two embolization techniques were employed: endovascular trapping of the hepatic artery (embolization of the hepatic artery proximal and distal to GDA stump; group A; n = 13) and selective embolization of the GDA stump and/or pseudoaneurysm sparing hepatic arterial flow (group B; n = 3). Technical success, initial hemostasis, recurrence of bleeding, and complications were compared between the two groups retrospectively.
  
  
  RESULTS
  All TAE procedures were technically successful and immediate hemostasis was achieved in all patients. There was no recurrent bleeding in group A; however, all three patients in group B experienced recurrent bleeding after initial hemostasis (P = .002), and these patients required subsequent embolization with the endovascular trapping technique. Two patients died of multiple organ failure (one patient in each group) despite successful hemostasis. Three patients experienced subsegmental (n = 1, group A) and multisegmental (n = 2, group B) liver infarction, which were successfully managed with conservative treatment. There was a higher incidence of major complications in group B (15.4% vs 100%; P = .018).
  
  
  CONCLUSIONS
  Endovascular trapping of the hepatic artery is a safe and effective treatment of pseudoaneurysms of the GDA stump after pancreaticoduodenectomy. Hepatic ischemic complications are not rare, but can be conservatively managed. Selective embolization of the GDA stump and/or pseudoaneurysm is frequently associated with recurrence of bleeding, which eventually leads to major complications.
authors.affiliation: Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, South Korea.
authors.forename: Saebeom
authors.initials: S
authors.lastname: Hur
authors.forename: Chang Jin
authors.initials: CJ
authors.lastname: Yoon
authors.forename: Sung-Gwon
authors.initials: SG
authors.lastname: Kang
authors.forename: Robert
authors.initials: R
authors.lastname: Dixon
authors.forename: Ho-Seong
authors.initials: HS
authors.lastname: Han
authors.forename: Yoo-Seok
authors.initials: YS
authors.lastname: Yoon
authors.forename: Jai Young
authors.initials: JY
authors.lastname: Cho
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000401:mortality; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D007511:Ischemia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D012008:Recurrence; D056910:Republic of Korea; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome