title: Late postpancreatectomy hemorrhage: Predictive factors of morbidity and mortality after percutaneous endovascular treatment.
abstract: OBJECTIVE
  The objective of this study was to evaluate the effectiveness of endovascular treatment in patients presenting with late hemorrhage after pancreatectomy (LPPH).
  
  
  METHODS
  Between 2008 and 2012, 53 percutaneous arterial procedures were performed in 42 patients with LPPH. There were 27 men and 15 women (mean age, 61.8 years±14.5 [SD]; range: 19-81 years). Clinical and technical success along with frequency of complications associated with the use of different endovascular techniques in patients with and without arterial anatomical variation were assessed.
  
  
  RESULTS
  Clinical success was observed in 35/42 patients (85%). The technical success was 37.5% in patients with anatomical variation versus 82.8% for those with modal anatomy (P=0.003). Repeat bleeding (P=0.029), complications (P=0.013) and mortality (P=0.045) were more frequent in patients with variation of celiac artery than in those with modal anatomy. For hepatic and gastroduodenal artery stump bleeding, the rate of complications was higher (60%) in the group treated by hepatic artery embolization (P=0.028) by comparison with gastroduodenal artery stump selective embolisations or treatments by covered stent. A significant difference in mortality rate was found between patients with anatomical variations of celiac artery (36.4%) and those with normal anatomy (6.5%) (P=0.032).
  
  
  CONCLUSIONS
  Percutaneous endovascular treatment is effective in patients presenting with LPPH. The presence of an anatomical variation of the celiac artery increases the rate of complications and mortality in patients with LPPH.
authors: Department of radiology, hôpital la Timone, 264, rue Saint-Pierre, 13005 Marseille, France. Electronic address: c.gaudon@hopital-europeen.fr.
authors: C
authors: C
authors: Gaudon
authors: Department of radiology, hôpital Nord, 13015 Marseille, France.
authors: J
authors: J
authors: Soussan
authors: Department of radiology, hôpital la Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
authors: G
authors: G
authors: Louis
authors: Department of surgery, hôpital Nord, 13015 Marseille, France.
authors: V
authors: V
authors: Moutardier
authors: Department of surgery, hôpital La Timone, 13005 Marseille, France.
authors: E
authors: E
authors: Gregoire
authors: Department of radiology, hôpital la Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
authors: V
authors: V
authors: Vidal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D004621:Embolization, Therapeutic; D004724:Endoscopy; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D010180:Pancreatectomy; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Arterial embolization; Hemorrhage; Interventional imaging; Pancreaticoduodenectomy; Pseudoaneurysm