title: Hepatic artery stent-grafts for the emergency treatment of acute bleeding.
abstract: OBJECTIVE
  We evaluated the technical success and clinical efficacy of stent-graft implantation for the emergency management of acute hepatic artery bleeding.
  
  
  METHODS
  Between January 2010 and July 2013, 24 patients with hemorrhage from the hepatic artery were scheduled for emergency implantation of balloon expandable stent-grafts. The primary study endpoints were technical and clinical success, which were defined as successful stent-graft implantation with sealing of the bleeding site at the end of the procedure, and cessation of clinical signs of hemorrhage. The secondary study endpoints were complications during the procedure or at follow-up and 30-day mortality rate.
  
  
  RESULTS
  In 23 patients, hemorrhage occurred after surgery, and in one patient hemorrhage occurred after trauma. Eight patients had sentinel bleeding. In most patients (n=16), one stent-graft was implanted. In six patients, two overlapping stent-grafts were implanted. The stent-grafts had a target diameter between 4mm and 7 mm. Overall technical success was 88%. The bleeding ceased after stent-graft implantation in 21 patients (88%). The mean follow-up was 137 ± 383 days. In two patients, re-bleeding from the hepatic artery occurred during follow-up after 4 and 29 days, respectively, which could be successfully treated by endovascular therapy. The complication rate was 21% (minor complication rate 4%, major complication rate 17%). The 30-day mortality rate was 21%.
  
  
  CONCLUSIONS
  Implantation of stent-grafts in the hepatic artery is an effective emergency therapy and has a good technical success rate for patients with acute arterial hemorrhage.
authors: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany. Electronic address: nadine.bellemann@med.uni-heidelberg.de.
authors: Nadine
authors: N
authors: Bellemann
authors: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany.
authors: Christof-Matthias
authors: CM
authors: Sommer
authors: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany.
authors: Theresa
authors: T
authors: Mokry
authors: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany.
authors: Nikolas
authors: N
authors: Kortes
authors: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany.
authors: Daniel
authors: D
authors: Gnutzmann
authors: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany.
authors: Theresa
authors: T
authors: Gockner
authors: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany.
authors: Anne
authors: A
authors: Schmitz
authors: Department of Surgery, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany; Department for Visceral, Thoracic and Vascular Surgery at the University Hospital, Technical University Dresden, Germany.
authors: Jürgen
authors: J
authors: Weitz
authors: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany.
authors: Hans-Ulrich
authors: HU
authors: Kauczor
authors: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany.
authors: Boris
authors: B
authors: Radeleff
authors: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany.
authors: Ulrike
authors: U
authors: Stampfl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D004630:Emergencies; D005260:Female; D006499:Hepatic Artery / Q000293:injuries*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D011138:Polytetrafluoroethylene
keywords: Acute hepatic artery bleeding; Hepatic artery; Stent-grafts