title: [Diagnosis and treatment of hemorrhage after pancreatoduodenectomy via digital subtraction angiography and transcatheter arterial embolization].
abstract: OBJECTIVE
  To evaluate the clinical diagnosis and treatment of hemorrhage after pancreatoduodenectomy via digital subtraction angiography (DSA) and transcatheter arterial embolization (TAE).
  
  
  METHODS
  The clinical and imaging data of 23 patients receiving DSA examination and TAE treatment due to hemorrhage after pancreatoduodenectomy at our interventional center from October 2012 to October 2014 were retrospectively reviewed. And the manifestations of DSA and therapeutic efficacies of TAE were summarized and analyzed.
  
  
  RESULTS
  Among them, 16 patients showed positive signs of extravasation of contrast medium (n = 8), pseudoaneurysm formation (n = 3), ruptured pseudoaneurysm plus extravasation of contrast medium (n = 2) and local vascular spasm and non-smooth arterial intima (n = 3). And the remainder with negative signs (n = 7) underwent surgery. The 16 patients with positive signs underwent TAE with a technical success rate of 16/16. And clinical success was achieved in 12/16 patients. Among 4 rebleeders, two were successfully managed by surgery. And bleeding was caused by stress ulcer in gastrojejunal anastomosis (n = 1) and necrosis of pancreatic stump (n = 1). Another two on conservative treatment died from multiple organ failure.
  
  
  CONCLUSIONS
  As first-line options, DSA and TAE are miniinvasive and accurate in the diagnosis and treatment of hemorrhage after pancreatoduodenectomy.
authors.forename: Tanyang
authors.initials: T
authors.lastname: Zhou
authors.forename: Junhui
authors.initials: J
authors.lastname: Sun
authors.forename: Yuelin
authors.initials: Y
authors.lastname: Zhang
authors.forename: Chunhui
authors.initials: C
authors.lastname: Nie
authors.forename: Guanhui
authors.initials: G
authors.lastname: Zhou
authors.forename: Tongyin
authors.initials: T
authors.lastname: Zhu
authors.forename: Weilin
authors.initials: W
authors.lastname: Wang
authors.forename: Shusen
authors.initials: S
authors.lastname: Zheng
mesh_terms: D017541:Aneurysm, False; D015901:Angiography, Digital Subtraction; D004621:Embolization, Therapeutic; D006470:Hemorrhage; D006801:Humans; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications; D012189:Retrospective Studies