title: Endovascular management of severe bleeding after major abdominal surgery.
abstract: BACKGROUND
  In this study we analyzed embolization and stent-graft results.
  
  
  METHODS
  Demographics, indications, procedures, and outcomes of patients treated with embolization or stent grafting for late postoperative bleeding after major abdominal surgery were retrospectively recorded. Outcomes were analyzed on an intention-to-treat basis.
  
  
  RESULTS
  Between 2004 and 2008, 14 consecutive patients (11 men and 3 women, mean age 64 years) were treated for hemorrhage responsible for shock in 6 patients (43%), occurring after pancreaticoduodenectomy (n=13) or subtotal gastrectomy (n=1). Mean onset occurred at 23 days postoperatively (range 7-75 days). Bleeding site included: the stump of the gastroduodenal artery (n=10), splenic artery (n=2), common hepatic artery (n=1), and right gastric artery (n=1). Initial success was obtained in 13 patients (93%); the only failure of stent-graft deployment required re-laparotomy. Treatment included embolization in 8 patients and stent grafting in 5 patients. In the embolization group, 5 complications (62%) occurred: 4 rebleeding and 1 gastric perforation, compared with no early complications in the stent-graft group. One patient died in each group. The mean follow-up was 25 months (range 6-57 months).
  
  
  CONCLUSIONS
  Stent grafting seems to provide definitive hemostasis and fewer complications compared with embolization.
authors.affiliation: Department of Vascular Surgery, University Hospital Nord, Marseille, France. Electronic address: mourad.boufi@ap-hm.fr.
authors.forename: Mourad
authors.initials: M
authors.lastname: Boufi
authors.forename: Alireza Afrapoli
authors.initials: AA
authors.lastname: Hashemi
authors.forename: Amine
authors.initials: A
authors.lastname: Azghari
authors.forename: Olivier
authors.initials: O
authors.lastname: Hartung
authors.forename: Olivier
authors.initials: O
authors.lastname: Ramis
authors.forename: Vincent
authors.initials: V
authors.lastname: Moutardier
authors.forename: Yves S
authors.initials: YS
authors.lastname: Alimi
mesh_terms: D000368:Aged; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome