title: Endovascular management of bleeding events following robotic pancreaticobiliary surgery.
abstract: OBJECTIVE
  To describe the utility, safety, and efficacy of endovascular intervention for treating bleeding events after robotic pancreaticobiliary surgery.
  
  
  METHODS
  In this retrospective study, six patients (male/female, 3/3; mean age, 64 years) with histories of robotic pancreaticobiliary resection were referred for endovascular management of delayed postoperative intra-abdominal hemorrhage. Visceral angiography was performed, and the sites of suspected arterial hemorrhage were interrogated with selective microcatheter arteriography. The visualized bleeding sources were treated using catheter-directed embolotherapy with metallic coils, bare metal or covered stent insertion, or a combination of the two. The measured outcomes included the technical success of the angiographic occlusion, procedure safety, and procedure efficacy.
  
  
  RESULTS
  Pseudoaneurysms resulted in bleeding in six cases (100%). The endovascular interventions included coil embolization in three cases (50%), covered stent exclusion in two cases (33%), and bare metal stent-assisted coil embolization in one case (17%). The technical success was 100%, with complete cessation of bleeding in all cases. No immediate or delayed procedure-related complications were encountered in any of the patients. The efficacy of the endovascular therapy was 100% in this series, with no recurrent hemorrhage during the mean clinical follow-up period of 262 days (range, 67-446 days).
  
  
  CONCLUSIONS
  Endovascular therapy provides a minimally invasive, safe, and effective method for managing hemorrhagic events after complicated pancreaticobiliary surgery.
authors.affiliation: Department of Radiology, University of Illinois at Chicago, Chicago, IL, USA. rongaba@yahoo.com
authors.forename: Ron C
authors.initials: RC
authors.lastname: Gaba
authors.forename: Vishal L
authors.initials: VL
authors.lastname: Khiatani
authors.forename: M Grace
authors.initials: MG
authors.lastname: Knuttinen
authors.forename: Benedictta O
authors.initials: BO
authors.lastname: Omene
authors.forename: Brandon K
authors.initials: BK
authors.lastname: Martinez
authors.forename: James T
authors.initials: JT
authors.lastname: Bui
authors.forename: Charles A
authors.initials: CA
authors.lastname: Owens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001662:Biliary Tract Surgical Procedures; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics