title: Clinical outcome of transarterial embolization for postgastrectomy arterial bleeding.
abstract: BACKGROUND
  The aim of this study was to retrospectively investigate the feasibility and safety of transcatheter arterial embolization in the management of postgastrectomy arterial bleeding.
  
  
  METHODS
  Between January 2004 and July 2015, 13,246 patients underwent total or subtotal gastrectomy at our institution, and 24 patients (18 men; mean age 66.8 years; range 42-80 years) underwent transcatheter arterial embolization for postoperative arterial bleeding identified on angiography.
  
  
  RESULTS
  Postgastrectomy arterial bleeding occurred after subtotal gastrectomy in 14 patients (58%) and after total gastrectomy in 10 patients (42%), after a mean of 17 days (range 1-57 days). It manifested itself as luminal bleeding in 10 patients and as abdominal bleeding in 14 patients. Technical success was achieved in all 24 patients (100%). The clinical success rate was 79% (19-24); there were three transcatheter-arterial-embolization-related major complications that resulted in death within 30 days (12%), one case of recurrent bleeding, and one case of persistent bleeding. The cause of death included infarctions in the spleen and/or remnant stomach (n = 2) and bowel perforation (n = 1). The commonest bleeding focus was the gastroduodenal artery (46%, 11 patients), followed by the splenic artery (29%, 7 patients). By surgery type, the gastroduodenal artery was the commonest site of bleeding in subtotal gastrectomy (64%, 9/14) and the splenic artery was commonest site of bleeding in total gastrectomy (50%, 5/10).
  
  
  CONCLUSIONS
  Transcatheter arterial embolization demonstrated high technical and clinical success rates with an acceptable complication rate in the management of postgastrectomy arterial bleeding. However, transcatheter arterial embolization may not be the best treatment option in patients who have undergone subtotal gastrectomy and bled from the splenic artery owing to the high risk of infarctions of the remnant stomach and the spleen.
authors.affiliation: Department of Radiology, Severance Hospital, Research Institute of Radiological Science, College of Medicine, Yonsei University, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea.
authors.forename: Kichang
authors.initials: K
authors.lastname: Han
authors.affiliation: Department of Radiology, Severance Hospital, Research Institute of Radiological Science, College of Medicine, Yonsei University, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea.
authors.forename: Bestun Mustafa
authors.initials: BM
authors.lastname: Ahmed
authors.affiliation: Department of Radiology, Severance Hospital, Research Institute of Radiological Science, College of Medicine, Yonsei University, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea. mdkim@yuhs.ac.
authors.forename: Man-Deuk
authors.initials: MD
authors.lastname: Kim
authors.affiliation: Department of Radiology, Severance Hospital, Research Institute of Radiological Science, College of Medicine, Yonsei University, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea.
authors.forename: Jong Yun
authors.initials: JY
authors.lastname: Won
authors.affiliation: Department of Radiology, Severance Hospital, Research Institute of Radiological Science, College of Medicine, Yonsei University, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea.
authors.forename: Do Yun
authors.initials: DY
authors.lastname: Lee
authors.affiliation: Department of Radiology, Severance Hospital, Research Institute of Radiological Science, College of Medicine, Yonsei University, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea.
authors.forename: Gyoung Min
authors.initials: GM
authors.lastname: Kim
authors.affiliation: Department of Radiology, Severance Hospital, Research Institute of Radiological Science, College of Medicine, Yonsei University, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea.
authors.forename: Joon Ho
authors.initials: JH
authors.lastname: Kwon
authors.affiliation: Department of Radiology, Severance Hospital, Research Institute of Radiological Science, College of Medicine, Yonsei University, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea.
authors.forename: Sung Il
authors.initials: SI
authors.lastname: Park
authors.affiliation: Department of Surgery, Severance Hospital, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Sung
authors.initials: S
authors.lastname: Hoon Noh
authors.affiliation: Department of Surgery, Severance Hospital, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Hyung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery; D016896:Treatment Outcome
keywords: Embolization; Gastrectomy; Gastric carcinoma; Hemorrhage; Infarction