title: Management of a delayed post-pancreatoduodenectomy haemorrhage using endovascular techniques.
abstract: BACKGROUND
  A delayed post-pancreatoduodenectomy haemorrhage is associated with a significant increase in peri-operative mortality. Endovascular techniques are frequently used for a delayed haemorrhage. However, limited data exists on the short- and long-term outcomes of this approach. A retrospective review over a 10-year period at a quaternary-referral pancreatic centre was performed.
  
  
  METHODS
  Between 2002-2012, 1430 pancreatoduodenectomies were performed, and 32 patients had a delayed haemorrhage (occurring >24 h post-operatively) managed by endovascular techniques. The clinicopathological variables related to a haemorrhage were investigated.
  
  
  RESULTS
  A total of 42 endovascular procedures were performed at a median of 25 days, with the majority of delayed haemorrhages occurring after 7 days. There were four deaths (13%) with three occurring in patients with a grade C haemorrhage. Seven patients (22%) experienced rebleeding, and two patients developed hepatic abscesses.
  
  
  CONCLUSIONS
  A delayed haemorrhage post-pancreaticoduodenectomy can be managed by endovascular techniques with acceptable morbidity and mortality. Rebleeding and hepatic abscesses may occur and can be managed non-operatively in most cases. The association of a delayed haemorrhage with a pancreatic fistula makes this a challenging clinical problem.
authors.affiliation: Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Kengo
authors.initials: K
authors.lastname: Asai
authors.affiliation: Division of Surgical Oncology, Hepatobiliary and Pancreatic Surgery, University of Virginia, Charlottesville, VA, USA.
authors.forename: Victor
authors.initials: V
authors.lastname: Zaydfudim
authors.affiliation: Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Truty
authors.affiliation: Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: K Marie
authors.initials: KM
authors.lastname: Reid-Lombardo
authors.affiliation: Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Kendrick
authors.affiliation: Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Florencia
authors.initials: F
authors.lastname: Que
authors.affiliation: Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: David
authors.initials: D
authors.lastname: Nagorney
authors.affiliation: Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: James
authors.initials: J
authors.lastname: Andrews
authors.affiliation: Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Farnell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome