title: Postpancreatoduodenectomy Hemorrhage Treated by Combined Transcatheter Arterial Embolization and Superior Mesenteric Artery to Iliac Artery Bypass: Report of a Case.
abstract: Postpancreatectomy hemorrhage is a potentially life-threatening complication. We report herein our experience with a 65-year-old man with locally advanced pancreatic adenocarcinoma who underwent pancreatoduodenectomy with lymphadenectomy following neoadjuvant chemoradiotherapy. On postoperative day 45, he developed massive hematemesis. Angiography revealed active bleeding from the common hepatic artery, and transcatheter coil embolization of that vessel was successfully performed. On postoperative day 64, he again developed massive hematemesis. Angiography revealed active bleeding from the proximal superior mesenteric artery. Immediately after coil embolization of that vessel, bypass grafting between the superior mesenteric artery and the right common iliac artery was performed, using a greater saphenous vein graft. The combination of embolization and bypass grafting is an option for treatment of bleeding from the superior mesenteric artery in an emergent situation.
authors.affiliation: Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Hayato
authors.initials: H
authors.lastname: Sasaki
authors.affiliation: Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Murakami
authors.affiliation: Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Uemura
authors.affiliation: Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sudo
authors.affiliation: Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Hashimoto
authors.affiliation: Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Naru
authors.initials: N
authors.lastname: Kondo
authors.affiliation: Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Taijiro
authors.initials: T
authors.lastname: Sueda
mesh_terms: D000368:Aged; D000792:Angiography; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D006499:Hepatic Artery; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D008297:Male; D017538:Mesenteric Artery, Superior / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D019106:Postoperative Hemorrhage / Q000628:therapy*; D012501:Saphenous Vein / Q000637:transplantation; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: Bleeding; Bypass; Pancreatoduodenectomy; Postpancreatectomy hemorrhage; Superior mesenteric artery