title: Covered Stents and Coil Embolization for Treatment of Postpancreatectomy Arterial Hemorrhage.
abstract: OBJECTIVE
  To evaluate the efficacy and clinical outcomes associated with stent-graft placement and coil embolization for postpancreatectomy arterial hemorrhage (PPAH).
  
  
  METHODS
  Retrospective review of 38 stent-graft and/or embolization procedures in 28 patients (23 men; mean age, 65.1 y) for PPAH between 2007 and 2014 was performed. Time of bleeding, source of hemorrhage, intervention and devices used, repeat intervention rate, time to recurrent bleeding, complications, and 30-day mortality were assessed. Independent risk factors for recurrent bleeding and 30-day mortality were identified.
  
  
  RESULTS
  Median onset of hemorrhage was at 39 days (mean, 27.9 d; range, 5-182 d). Covered stents were used in 65.7% of interventions, coil embolization in 23.6%, stent-assisted embolization in 5.2%, and stent-graft angioplasty in 2.6%. A total of 28 stent-grafts were placed, of which 19 were self-expandable and nine were balloon-mounted. Mean stent-graft diameter was 6.6 mm (range, 5-10 mm). Recurrent bleeding occurred following 26.3% of interventions in seven patients at a mean interval of 22 days. The site of recurrent bleeding was new in 80% of cases. There was no significant difference in recurrent bleeding rate in early-onset (< 30 d; n = 22) versus late-onset PPAH (> 30 d; n = 6; P > .05). No ischemic hepatic or bowel complications were identified. The 30-day mortality rate was 7.1% (n = 2) and was significantly higher in patients with initial PPAH at ≥ 39 days (n = 5; P = .007).
  
  
  CONCLUSIONS
  Covered stents and coil embolization are effective for managing PPAH and maintaining distal organ perfusion to minimize morbidity and mortality. Recurrent bleeding is common and most often occurs from new sites of vascular injury rather than previously treated ones.
authors.affiliation: Department of Radiology, University of Pittsburgh Medical Center, 3950 Presby South Tower, 200 Lothrop St., Pittsburgh, PA 15213. Electronic address: kevinchingmd@gmail.com.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Ching
authors.affiliation: Department of Radiology, University of Pittsburgh Medical Center, 3950 Presby South Tower, 200 Lothrop St., Pittsburgh, PA 15213.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Santos
authors.affiliation: Department of Radiology, University of Pittsburgh Medical Center, 3950 Presby South Tower, 200 Lothrop St., Pittsburgh, PA 15213.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: McCluskey
authors.affiliation: Department of Radiology, University of Pittsburgh Medical Center, 3950 Presby South Tower, 200 Lothrop St., Pittsburgh, PA 15213.
authors.forename: Phillip D
authors.initials: PD
authors.lastname: Orons
authors.affiliation: Department of Radiology, University of Pittsburgh Medical Center, 3950 Presby South Tower, 200 Lothrop St., Pittsburgh, PA 15213.
authors.forename: Rupal
authors.initials: R
authors.lastname: Bandi
authors.affiliation: Department of Radiology, University of Pittsburgh Medical Center, 3950 Presby South Tower, 200 Lothrop St., Pittsburgh, PA 15213.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Friend
authors.affiliation: Department of Radiology, University of Pittsburgh Medical Center, 3950 Presby South Tower, 200 Lothrop St., Pittsburgh, PA 15213.
authors.forename: Minzhi
authors.initials: M
authors.lastname: Xing
authors.affiliation: Department of Surgery, University of Pittsburgh Medical Center, 3950 Presby South Tower, 200 Lothrop St., Pittsburgh, PA 15213.
authors.forename: Amer H
authors.initials: AH
authors.lastname: Zureikat
authors.affiliation: Department of Surgery, University of Pittsburgh Medical Center, 3950 Presby South Tower, 200 Lothrop St., Pittsburgh, PA 15213.
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Zeh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation; D004621:Embolization, Therapeutic; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome