title: Endovascular treatment of delayed hemorrhage developing after the pancreaticoduodenectomy procedure.
abstract: OBJECTIVE
  Delayed hemorrhage after pancreaticoduodenectomy (PD) is still one of the most common causes of mortality. However, the case series regarding interventional treatment of delayed hemorrhage after PD are limited. In this retrospective study, we aimed to evaluate functional outcomes of interventional treatment of late hemorrhages developing after PD.
  
  
  METHODS
  We retrospectively evaluated 16 patients who received endovascular treatment for delayed arterial hemorrhage after PD procedure. Postsurgical nonhemorrhagic complications, time of hemorrhage, site of hemorrhage, endovascular treatment technique, postprocedural complications, and mortality rates were obtained.
  
  
  RESULTS
  Mean duration of delayed hemorrhage after PD was 18 days. Computed tomography angiography images for the hemorrhage period were available for 15 patients. We observed extravasation alone in seven patients and pseudoaneurysm alone in five. Pushable coil was used in 15 patients and covered stent in 1. Two patients died due to hepatic failure, and one patient died because of multiple organ dysfunction syndrome (MODS).
  
  
  CONCLUSIONS
  Delayed hemorrhage after PD is difficult to identify, but accurate and early diagnosis is of vital importance. To date, most appropriate management of this complication remains unclear. Although endovascular treatment techniques may vary for every patient, it is a reliable and effective method for halting hemorrhage. Therefore, interventional procedures must be primarily considered rather than surgical interventions.
authors.affiliation: Department of Intervention Radiology, Canakkale 18 Mart University Medicine Faculty, Canakkale, Turkey, gurhanadam@hotmail.com.
authors.forename: Gurhan
authors.initials: G
authors.lastname: Adam
authors.forename: Sukru
authors.initials: S
authors.lastname: Tas
authors.forename: Celal
authors.initials: C
authors.lastname: Cinar
authors.forename: Halil
authors.initials: H
authors.lastname: Bozkaya
authors.forename: Fusun
authors.initials: F
authors.lastname: Adam
authors.forename: Fatma
authors.initials: F
authors.lastname: Uysal
authors.forename: Mustafa
authors.initials: M
authors.lastname: Resorlu
authors.forename: Omer Vedat
authors.initials: OV
authors.lastname: Unalp
authors.forename: Mustafa
authors.initials: M
authors.lastname: Parildar
authors.forename: Erdem
authors.initials: E
authors.lastname: Koçak
authors.forename: Huseyin
authors.initials: H
authors.lastname: Ozdemir
mesh_terms: D000328:Adult; D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D000792:Angiography; D015901:Angiography, Digital Subtraction; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents